Fahad D. Alosaimi

A Review of Sleep Disturbance in Hepatitis C

Sleep disturbances occur in up to 60% of patients with chronic hepatitis C (CHC) and is often interrelated with comorbid psychiatric disorders. Moreover, neuropsychiatric complications of interferon-α during CHC treatment can manifest as sleep problems. Newly diagnosed sleep disturbance occurs in up to 60% and 30% of untreated CHC patients and patients undergoing interferon-α therapy, respectively. However, the presentation of insomnia in patients with CHC is influenced by significant psychiatric comorbidity, such as depression, and medical conditions, such as anemia and hypothyroidism. Therefore, prompt recognition using screening tools and exclusion of comorbid conditions contributing sleep pathology can enhance treatment outcomes. Owing to the paucity of studies, treatment recommendations for sleep disorders in CHC patients are derived from recommendations from general sleep disorder treatment guidelines. Further research is needed to elucidate the efficacy of pharmacological and nonpharmacological treatments of sleep disorders in CHC patients.

A Comparison of Depression Screening Instruments in Hepatitis C and the Impact of Depression on Somatic Symptoms

OBJECTIVE Treatment of hepatitis C (HCV) with pegylated interferon-alpha (IFNα) can cause depression in approximately 30% of patients and underscores the need for effective detection of depression prior to and during IFNα treatment. Elevated rates of depression in untreated HCV can be a barrier to initiating HCV therapy and can impact fatigue and physical symptoms. In this preliminary study, we examined the accuracy of the seven-item Hamilton Depression Rating Scale (HAM-7) and Patient Health Questionnairre-9 (PHQ-9) in detecting depression in HCV-infected patients and determined the effect of major depression on somatic symptoms. METHODS We conducted a preliminary comparison of operating characteristics of the PHQ-9 and HAM-7 to the MINI International Neuropsychiatric Interview for major depression in 116 individuals with chronic HCV assessed in an ambulatory office setting. We also examined the differences in fatigue and somatic symptoms in depressed HCV-infected patients. RESULTS Currently depressed chronic hepatitis C patients had significantly higher scores on all the scales compared with nondepressed patients. HAM-7 and PHQ-9 scores were significantly correlated with somatic and physical symptoms scales. Both the PHQ-9 and HAM-7 demonstrated comparable accuracy in detecting depression in comparison to the MINI. CONCLUSIONS Our results suggest that the HAM-7 and PHQ-9 both have good operating characteristics compared with a criterion standard measure. Given that depression was associated with fatigue and increased somatic complaints, improved detection and treatment of depression could reduce disability and facilitate treatment for depressed HCV-infected patients.

The prevalence of psychiatric disorders among visitors to faith healers in Saudi Arabia.

Objective: We investigated the prevalence of psychiatric disorders among visitors to Faith Healers (FHs) in Riyadh, Saudi Arabia. We also studied the sociodemographic profiles for these visitors, in addition to their past psychiatric history, reason(s) for seeking FH help, and past and current treatment experience with FHs. Methods: We conducted a cross-sectional study among the visitors (n=321) to a number of faith healing settings in Riyadh, Saudi Arabia using a specially designed questionnaire and validated Arabic version of The Mini International Neuropsychiatric Interview. Results: Most of the participants were young adults (35.1±10.8 years) and males with intermediate and secondary levels of education who had not sought medical help prior to their visits. A high proportion of the FH visitors have diagnosable mental illnesses. Depressive and anxiety disorders were the most prevalent among the study participants; few visitors were affected by psychotic or bipolar disorders. Conclusions: The present study provides insight for understanding the type of patients with psychiatric disorders who visit Faith Healers.(FHs). The study highlights the tendency of psychiatric patients in Saudi Arabia to visit FHs, which could reflect the importance of further studies to clarify the impact of FHs on the management of those patients.

Smartphone addiction among university students in Riyadh, Saudi Arabia

Objectives: To investigate the prevalence and correlates of smartphone addiction among university students in Saudi Arabia. Methods: This cross-sectional study was conducted in King Saud University, Riyadh, Kingdom of Saudi Arabia between September 2014 and March 2015. An electronic self administered questionnaire and the problematic use of mobile phones (PUMP) Scale were used. Results: Out of 2367 study subjects, 27.2% stated that they spent more than 8 hours per day using their smartphones. Seventy-five percent used at least 4 applications per day, primarily for social networking and watching news. As a consequence of using the smartphones, at least 43% had decrease sleeping hours, and experienced a lack of energy the next day, 30% had a more unhealthy lifestyle (ate more fast food, gained weight, and exercised less), and 25% reported that their academic achievement been adversely affected. There are statistically significant positive relationships among the 4 study variables, consequences of smartphone use (negative lifestyle, poor academic achievement), number of hours per day spent using smartphones, years of study, and number of applications used, and the outcome variable score on the PUMP. The mean values of the PUMP scale were 60.8 with a median of 60. Conclusion: University students in Saudi Arabia are at risk of addiction to smartphones; a phenomenon that is associated with negative effects on sleep, levels of energy, eating habits, weight, exercise, and academic performance.

Prevalence of stress and its determinants among residents in Saudi Arabia

Objectives: To examine perceived stress among residents in Saudi Arabia and its associated risk factors. Methods: A cross-sectional study of all residents registered at the Saudi Commission for Health Specialties, Riyadh, Saudi Arabia, was conducted between May and October 2012. We assessed the likelihood of stress using the perceived stress scale (PSS). Results: Out of the 4000 residents contacted, 1035 responded and 938 were included. The mean (±standard deviation) PSS score was 22.0±5.1 (median 22 and inter-quartile range of 18-25). With the exception of gender and nationality, no significant associations were found between stress and socio-demographic or behavioral factors. Stress was associated with higher workload, sleep deprivation, dissatisfaction with colleagues and the program, and harmful ideations. Stressors included work-related, academic, and homesickness stressors. In multivariate analysis, the following were independently associated with stress: Saudi nationality, facing homesick stressor, facing work-related stressor, dissatisfaction with relationships with colleagues, and frequent thoughts of quitting the medical profession. Conclusion: Residents in Saudi Arabia are at comparable or slightly higher risk of perceived stress than that reported among residents worldwide. Unfortunately, most of the participants never received stress management, which highlights the need for stress management programs during residency.

Physicians' attitudes towards interaction with the pharmaceutical industry.

The relationship between physicians and the pharmaceutical industry has ethical implications for patient care. This study examined knowledge and attitudes towards the pharmaceutical industry, and associations with actual behaviour, among physicians working in Saudi Arabia. In a cross-sectional study in 2012, a 100-point score was created from 17 5-point Likert-scale questions to assess knowledge and attitudes. The overall score of 659 participants was 63.1 (SD 8.5), with a majority holding a generally positive attitude. Higher (i.e. better) scores were significantly associated with a lack of interactions with the pharmaceutical industry and with refusal of gifts but not with education about ethics. In multivariate analysis, refusing gifts, additional income and Saudi nationality remained independently associated with higher scores. Overall, there was suboptimal knowledge and a generally positive attitude towards the pharmaceutical industry among the sample of physicians in Saudi Arabia.

Interactions between physicians and pharmaceutical sales representatives in Saudi Arabia.

BACKGROUND AND OBJECTIVES Interaction between physicians and pharmaceutical sales representative (PR) is a major component of the promotional activities by pharmaceutical companies. The lack of studies examining the magnitude of this interaction in Saudi Arabia is evident. The objective of this study is to estimate the magnitude and associated characteristics of physician-PR interaction. DESIGN AND SETTINGS A cross-sectional study was conducted among physicians working in the different regions of Saudi Arabia between March and July of 2012. METHODS A cross-sectional study was undertaken between March and July of 2012 in the different regions of Saudi Arabia. A self-administrated questionnaire was developed and handed to all participants, both in paper and electronic formats. RESULTS A total of 663 participants completed the questionnaire. The participation rate was 66.3% (663/1000). The majority of the participants (72.9%) reported interaction with PRs. This was lower among residents/interns compared to higher ranking employees (55.6% vs 83.6%, P<.001). Approximately half (48.3%) of the interactions occurred at a rate of more than once a month. A majority of the participants (72.1%) occasionally accepted gifts such as stationery (57%), drug samples (54%), meals (38%), and sponsorship of educational activities (30%). The following characteristics were independently associated with physician-PR interaction: non-Saudi nationals, a higher monthly income, Western medical education, working in a private hospital, being a specialist or registrar (rather than resident or intern), working on certain specialties (such as psychiatry and family medicine), and having limited number of patients with high socioeconomic status. CONCLUSION Although lower than seen in many parts of the world, a high prevalence of physician-PR interaction in Saudi hospitals is reported. Delineating associated characteristics may assist with future interventions. Further research should focus on ethical, clinical, prescription, and economic impact of interaction as well as determining the best strategy to reduce negative impact.

Work-Related Stress and Stress-Coping Strategies among Patients Companions at a Tertiary Care Hospital in Saudi Arabia

Providing care to hospitalized patients may be associated with stress, reduced quality of life, and even psychiatric disorders. This case-control study aimed to compare the level of stress (using the 14-question perceived stress scale (PSS-14), potential risk factors, and stress-coping strategies (using the 28-item brief coping scale (BCS-28) between two convenient samples of patients’ companions (56) and administrative employees (98) working in a tertiary care hospital in Saudi Arabia. The average PSS-14 was slightly higher in companions than administrative employees (27.4 ± 9.9 vs. 25.1 ± 10.1, p=0.179). After stratifying by gender, the difference in males (but not females) was marginally significant in the unadjusted comparison and significant in the adjusted comparison. Companions had similar scores of adaptive stress-coping strategies but higher scores of maladaptive stress-coping strategies compared with administrative employees. This was especially apparent in the denial and self-distraction strategies. PSS-14 in all participants had a moderate significant positive correlation with maladaptive stress-coping strategies. Companions exhibited a gender-specific slight increase in the level of stress and adopted more maladaptive stresscoping strategies compared with administrative employees. There were no group differences in blood lipids, serum glucose, or cortisol levels.

Association of help-seeking behavior with depression and anxiety disorders among gastroenterological patients in Saudi Arabia

Background/Aims: There is a high prevalence of depression and anxiety disorders among gastroenterological outpatients. Relatively few studies have been done on the help-seeking behavior among those who suffer from gastrointestinal symptoms with or without psychiatric disorders. We aimed to characterize the help-seeking behavior of gastroenterological outpatients and to evaluate if this behavior is linked to the presence of depression and anxiety. Patients and Methods: A cross-sectional study was carried out in gastroenterology clinics in four hospitals in Riyadh between February and September 2013. A self-administrated questionnaire was developed and administered to patients. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) questionnaires were used to diagnose depression and anxiety, respectively. Results: A total of 440 patients completed the study questionnaire. The average age was 36.0 ± 12.8 years and 69% of the patients were males. Complaints included abdominal pain (58%), heartburn (29%), diarrhea or constipation (25%), appetite or weight changes (22%), and nausea or vomiting (16%). Depression was diagnosed in 36%, while anxiety was diagnosed in 28% of the patients. The first intervention was use of medications (68%) and undergoing endoscopy (16%), while few patients initially used herbs or Islamic incantation (7.5%). This first intervention was done primarily (59%) in private sector hospitals rather than government sector hospitals (36%). The rates of depression and anxiety in our patients were higher among those who suffered from multiple complaints for longer durations and with less satisfaction with the offered services. Conclusion: Depression and anxiety are common comorbidities in gastroenterological outpatient population, especially those who have a chronic course of multiple gastrointestinal complaints.

Broken heart: Broken mind.

The increased frequency of sudden cardiac death after earthquakes and bombings has long proposed that emotional distress plays a role in acute coronary syndromes and arrhythmias. Since the 1960s, several controlled, prospective, epidemiological studies have reported emotional distress as a major risk factor for the onset and worsening of coronary heart disease (CHD) [1]. The Interheart study, a case control trial of around 29,000 participants in 52 countries, has found that psychosocial risk factors, including stress, depression, and low generalized locus of control, are responsible for 32.5% of the population attributable risk for myocardial infarction (MI). This is independent of, and only slightly less than, the population attributable risk for lifetime smoking (35.7%) and greater than that for hypertension (17.9%) or obesity (20.0%) [2]. Also, depression has repeatedly been found in many studies to predict earlyonset CHD; increased post-MI mortality (1.5–5.07 times risk); and increased cardiac symptoms such as chest pain and fatigue [3]. Based on the abovementioned data which provides compelling evidence that depression is associated with a worse outcome in CHD population, there is a need to examine mediators that explain this association. A number of behavioral and biological factors were implicated including lack of exercise, diabetic dyscontrol, smoking, medication noncompliance, HPA axis dysregulation, platelet aggregation, vascular inflammation, endothelial dysfunction, decreased heart rate variability, autonomic instability, and hypertension. One of the clinical mediators is severity and the treatment-resistant quality of depression. Recently, a follow-up analysis of the SADHART trial found patients who failed to recover from depression after a CHD event or scored greater than 18 on the Hamilton Depression Rating (HAM-D) scale in the first 2 weeks post MI to have doubled the mortality rate compared to those who return to psychological health even 7 years after the initial cardiac event [4]. Furthermore, researchers studied different depressive symptoms and psychosocial constructs as a predictive factor of hypertension and CHD. Chida and Steptoe [5], in their major meta-analysis of 80,000 individuals, demonstrated that anger and hostility were associated with a 19% increase in CHD events in healthy individuals especially