Muhammad Ajmal Zahid

Coping with Infertility among Kuwaiti Women: Cultural Perspectives

Backgrounds: Although previous studies conducted in western countries have reported that psychological factors are part of the experience of infertility, no study has assessed this relationship in Arab women. Aims: To examine psychological distress among Kuwaiti women with infertility problems and explore the perceived causes of infertility. Methods: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. Results: Compared with age-matched pregnant control sample. The infertile women exhibited a significant higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes such as evil spirits, witchcraft and God’s retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were considered as the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness results in social stigmatization for infertile women and places them at risk of serious social and emotional consequences. Conclusions: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicates the appropriateness of referring these patients for psychological evaluation. Successful programmes in dealing with infertility in Kuwait need to include the establishment of a community based intervention strategy to educate people about infertility and to give guidelines for treatment options.

Relationship of family caregiver burden with quality of care and psychopathology in a sample of Arab subjects with schizophrenia

BackgroundAlthough the burden experienced by families of people with schizophrenia has long been recognized as one of the most important consequences of the disorder, there are no reports from the Arab world. Following the example of the five - nation European (EPSILON) study, we explored the following research question: How does the relationship between domains of caregiving (as in the Involvement Evaluation Questionnaire - IEQ-EU) and caregiver psychic distress on the one hand, and caregivers/patients socio-demographics, clinical features and indices of quality of care, on the other hand, compare with the pattern in the literature?MethodConsecutive family caregivers of outpatients with schizophrenia were interviewed with the IEQ-EU. Patients were interviewed with measures of needs for care, service satisfaction, quality of life (QOL) and psychopathology.ResultsThere were 121 caregivers (66.1% men, aged 39.8). The IEQ domain scores (total: 46.9; tension: 13.4; supervision: 7.9; worrying: 12.9; and urging: 16.4) were in the middle of the range for the EU data. In regression analyses, higher burden subscale scores were variously associated with caregiver lower level of education, patients female gender and younger age, as well as patients lower subjective QOL and needs for hospital care, and not involving the patient in outdoor activities. Disruptive behavior was the greatest determinant of global rating of burden.ConclusionOur results indicate that, despite differences in service set-up and culture, the IEQ-EU can be used in Kuwait as it has been used in the western world, to describe the pattern of scores on the dimensions of caregiving. Differences with the international data reflect peculiarities of culture and type of service. Despite generous national social welfare provisions, experience of burden was the norm and was significantly associated with patients disruptive behavior. The results underscore the need for provision of community - based programs and continued intervention with the families in order to improve the quality of care.

Psychiatric Morbidity among Housemaids in Kuwait a. Prevalence of Psychiatric Disorders in the Hospitalized Group of Housemaids

Objectives: To determine the first hospital admission rates and the nature of psychiatric disorders among housemaids and compare them with the Kuwaiti female patients. Subjects and Methods: Based on the International Classification of Diseases (10th revision; ICD-10) symptom checklist, a semi-structured interview was administered to all the housemaids and the Kuwaiti female patients hospitalized during the 2-year study period. Results: The hospital admission rates were 1.86 times higher in housemaids than in the Kuwaiti female patients and the nature of psychiatric disorders was also different in the two groups. The stress-related disorders were more common among housemaids while schizophrenia was the commonest disorder among Kuwaiti patients. Duration of hospital stay was significantly shorter for housemaids, and four fifths of them were repatriated on mental health grounds. Conclusions: The psychiatric morbidity is higher among housemaids than Kuwaiti females and a substantial number of them are prematurely repatriated on health grounds. Further studies are needed to explore the possible pre-immigration risk, and post-immigration precipitating factors, to prevent this ‘expatriate failure’.

Psychiatric morbidity among housemaids in Kuwait III: Vulnerability factors

Background: Housemaids are a relatively homogenous immigrant subgroup in terms of their gender; ethnic origin; and socio-cultural, educational and occupational background. Psychiatric morbidity among housemaids is two to five times higher than the native female population. Aims: To determine the possible pre-immigration risk factors for prospective psychiatric breakdown among the housemaids. Methods: The sample consisted of all the housemaids (N = 197) hospitalised during the two-year study period. The controls comprised all the newly arrived housemaids (N = 502). The measures obtained included demographic characteristics and previous history of physical illness, psychiatric illness, hospitalisation and family history of psychiatric disorder. Results: More than a quarter of the hospitalised group broke down within one month of their arrival. The hospitalised group had a significant excess of Sri Lankan housemaids; non-Muslims; those with less than four years of education and those with a previous history of physical illness, psychiatric illness or hospitalisation. Conclusions: A number of potential risk factors results in premature repatriation of housemaids on mental health grounds. Preventive measures involving recruitment procedures and pre-departure orientation courses are needed to minimise the expatriate failure among the housemaids.

Schizophrenia Psychopathology in a Kuwaiti Arab Sample

Background: The heterogeneity of schizophrenia psychopathology has led to a search for symptom clusters that could be related to broad features of the disease. The objectives of the study were to: (1) highlight the pattern of symptoms among Kuwaiti subjects with schizophrenia, using the ICD-10 symptom checklist; (2) assess the factor structure of the Brief Psychiatric Rating Scale 18 (BPRS-18) and BPRS-24, and (3) evaluate the relationship of the resulting factors with sociodemographic characteristics, age at onset of illness, family history of mental illness, objective indicators of quality of life, self-esteem, affect balance, family caregiver burden, patient’s perceptions of service satisfaction and needs for care. Method: Consecutive outpatients in stable condition were assessed with the BPRS and ICD-10 symptom checklist, as well as measures of quality of life, needs for care, service satisfaction and family caregiver burden. Results: There were 130 patients (66.1% men, mean age = 36.8 years, age at onset of illness = 24.2 years, duration of illness = 12.9 years). Of the ICD-10 symptoms, the commonest positive symptoms were hallucinations (58.5%) and delusions (72%). Catatonic symptoms were rare (2.9%). About a quarter of the subjects experienced 4 of the negative symptoms. In exploratory factor analysis, we broadly replicated the known syndromes for BPRS-24 (disorganization, positive, activation, manic, negative and depression) and BPRS-18 (negative, positive, activation and affect). In regression analyses, the variables independently associated with psychopathology were family income, negative affect, self-esteem, duration of illness, age, lack of money for enjoyment, met needs for care and caregiver tension. The negative syndrome had more significant associations with the variables investigated than the positive syndrome. Psychopathological scores were separable from indices of psychological well-being. Conclusion: In this first study of schizophrenia psychopathology from the Arab world, the clinical manifestations were similar to the data from the developed countries. The persistence of psychotic symptoms despite freely available antipsychotic treatment and the impact on caregiver burden call for attention to the perennial issue of treatment resistance and underscore the need for continued interaction with family members after the acute inpatient phase of treatment, in order to address the impact of symptoms.

Psychiatric Morbidity among Medical Out-Patients in Kuwait: Evaluation of a Somatic Inventory to Identify the Psychiatric from the Non-Psychiatric Patients

Objectives: The aim of this study was to evaluate the Bradford Somatic Inventory (BSI), a 21-item questionnaire, to identify psychiatric patients attending a general hospital medical clinic in Kuwait. Methods: The sample consisted of 100 new general hospital medical out-patient clinic attendees. All patients were administered the BSI, and their psychiatric status was established by administration of the Present State Examination. All the patients who met the criteria of the International Classification of Diseases, 10th revision (ICD-10), were grouped as ‘psychiatric’ while the remaining subjects were regarded as ‘non-psychiatric’ patients. The frequency of endorsement and the total BSI scores were computed to determine sensitivity, specificity and positive predictive values of the BSI. Results: Fifty-one of the psychiatric patients met the ICD-10 diagnostic criteria. The psychiatric group reported a significantly higher number of BSI symptoms and had a significantly higher mean BSI total score than the non-psychiatric patients. Using a cut-off score of 13/14, the BSI-21 yielded a sensitivity rate of 72.5% and a specificity rate of 73.47%. Evaluation of a shorter version, the BSI-15, comprising the most frequently endorsed items by the psychiatric patients, revealed similar results. Conclusions: The findings suggest that the BSI-21 is a potentially useful screening instrument to identify psychiatric patients attending general medical out-patient clinics. The shorter version, BSI-15, is easier to administer and equally effective in discriminating the psychiatric from the non-psychiatric group of medical patients.

Introducing the Objective Structured Clinical Examination (OSCE) in the Undergraduate Psychiatric Curriculum: Evaluation after One Year.

ObjectiveThe Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry clerkship in 2008. The authors studied the effect of OSCE on the students’ performance.MethodsThe “short case” (SC) and “oral examination” (OE), two of the five components of the previous assessment format, were replaced with the OSCE. Results were compared with those of the 2007 students.ResultsThe introduction of the OSCE had little impact on the overall scores, but the 2007 students had significantly higher scores on the essay examination and long case, whereas the 2008 group had significantly higher scores on the OSCE (versus the OE for the 2007 group). In comparing the top 10 scoring students from the two classes, the 2007-year students had significantly higher overall scores, both on end-of-course tests and the annual examinations. In particular, the scores for the OSCE exams for the 2008 class were significantly lower than the scores for the OE in the 2007 class.ConclusionThe higher scores on OSCE in Year 2008 suggest that students performed better on clinical skills and professional development than recall on the factual-knowledge domains. Since the changes were introduced in the year 2008, the comparison can best be regarded as qualitative, and it is probably too early to judge the impact of the OSCE. Further studies to determine validity of the OSCE are needed.

Comparison of the problem based learning-driven with the traditional didactic-lecture-based curricula

Objectives To compare the Problem-based learning (PBL) with the traditional lecture-based curricula. Methods The single best answer Multiple Choice Questions (MCQ) and the Objective Structured Clinical Examination (OSCE) were used to compare performance of the lecture-based curriculum with the PBL medical student groups. The reliability for the MCQs and OSCE was calculated with Kuder-Richardson formula and Cronbach’s alpha, respectively. The content validity of the MCQs and OSCE were tested by the Independent Subject Experts (ISE). The Student’s t-test for independent samples was used to compare the item difficulty of the MCQs and OSCE’s, and the Chi-square test was used to compare the grades between the two student groups. Results The PBL students outperformed the old curriculum students in overall grades, theoretical knowledge base (tested with K2 type MCQs) and OSCE. The number of the PBL students with scores between 80-90% (grade B) was significantly (p=0.035) higher while their number with scores between 60 to 69% (grade C) was significantly p=0.001) lower than the old curriculum students. Similarly, the mean MCQ and the OSCE scores of the new curriculum students were significantly higher (p = 0.001 and p = 0.025, respectively) than the old curriculum students. Lastly, the old curriculum students found the K2-MCQs to be more (p = 0.001) difficult than the single correct answer (K1 type) MCQs while no such difference was found by the new curriculum students. Conclusions Suitably designed MCQs can be used to tap the higher cognitive knowledge base acquired in the PBL setting.

Mental and physical comorbidity in an Arab primary health care setting

BackgroundThere are no published studies on the comorbidity of common mental conditions (anxiety, depression, and somatization) and physical illnesses in the Arab world. Our aim was to estimate the prevalence of common mental conditions comorbid with physical illnesses among primary care attenders in Kuwait, and the sociodemographic characteristics associated with this comorbidity.MethodsThe Patient Health Questionnaires for somatization, anxiety and depression (PHQ-SAD) were administered to a representative sample of 1046 attenders (M: F = 429: 617; mean age 37.6, SD 12.7) seen in primary care clinics in Kuwait. Based on well-established cut-off scores, the presence and severity of three mental conditions –depression, anxiety, and somatization—was ascertained; physical diagnoses were ascertained by the attending physicians.ResultsOf 1046 respondents, 442 (42.3%) had at least one mental condition and 670 (64.1%) had a physical illness diagnosis, viz.: diabetes mellitus (248/670 = 37.0%), hypertension (229/670 = 34.2%), asthma (82/670 = 12.2%), non-chronic physical illnesses (63/670 = 9.4%), or heart disease (48/670 = 7.2%), with 34.4% (360/1046) having mental-physical comorbidity. Male: female ratio for the 670 subjects was 287: 383. The unadjusted odds ratio (OR) for having a mental condition in those with a physical illness vs. those without a physical illness was 4.16 (95% C.I. = 3.12, 5.55). Comorbidity was associated with older age, being divorced or widowed, a lower level of education, and poorer living conditions. Regardless of the physical illness, the most frequent comorbid mental disorder was somatization. The prevalence and severity of mental conditions were associated with the number of physical illnesses.ConclusionAs has been reported in other parts of the world, somatization, anxiety, and depression are highly prevalent among primary care attenders in Kuwait and they are typically comorbid with physical illness. Strategies for their prevention and treatment need to take into consideration their association with physical illness and social disadvantage.

Ekbom’s Syndrome: Delusional Disorder, Somatic Type, Treatment with Trifluoperazine

Since Ekbom’s classical description was first published in 1938, numerous case reports of Ekbom’s syndrome have been reported. Claims have been made that pimozide exerts a specific therapeutic effect