Wadih J. Naja

Prevalence of depression in Syrian refugees and the influence of religiosity.

BACKGROUND Many surveys have underlined the high levels of distress Syrian refugees have endured since the conflict aroused in their country, yet few have used reliable diagnostic tools for the clinical assessment of resulting mental disorders. The aim of our study is to assess for the onset of new depressive disorders following the Syrian war, and to investigate the correlation of religiosity with depression. METHODS Single individual interviews were used, in a sample of 310 Syrian forced migrants, retrospectively assessing for depressive disorders with onset at different timelines of the conflict outbreak. Religiosity was assessed in a cross-sectional design using a reliable, recently developed and tested tool. Bivariate analysis and logistic regression analysis were used with a level of significance at 0.05. RESULTS The prevalence of current depression was 43.9% (95% Confidence Interval (CI): 38.5-49.4%) with no difference across all socio-demographic factors, including gender. The overall mean for religiosity for the current sample was moderate (mean=9.76; standard deviation SD=2.34). No substantial correlation was found with religiosity. The prevalence rate for pre-war depression was 6.5% (95% CI: 4.2-9.8%) following the global pattern of socio-demographic epidemiological characteristics. Prevalence for past depression was 27.1% (95% CI: 22.5-32.3%); for current dysthymia: 4.5% (95% CI: 2.7-7.4%); for prewar and past dysthymia: 1% (95% CI: 0.3-2.8%), all with no significant differences detected across all demographic variables. CONCLUSION In this retrospective study on a sample of Syrian refugees who fled their country after the war, we found a substantial emergence of depressive disorders with no meaningful correlation with the level of religiosity.

Hyperammonemia Induced by Interaction of Valproate and Quetiapine

INTRODUCTION Hyperammonemia is one of the rare nevertheless serious side effects associated with valproic acid treatment. Two cases of valproic acid induced hyperammonemia are detailed in this article. CASES Case one describes an adult male who developed hyperammonemia after acute exposure to valproic acid as a treatment for his bipolar disorder-manic episode. Case two developed a similar pattern of toxicity but after chronic exposure to valproic acid. Both patients were receiving a combination of valproic acid and quetiapine. DISCUSSION Measurement of the ammonium level should be considered where there is a decreased level of consciousness in patients receiving valproic acid irrespective of the diagnosis and even after a long term exposure. A possible risk of hyperammonemia can result from a combination of valproic acid and quetiapine, however further studies are yet needed to confirm this hypothesis.

Prevalence of Depression in Medical Students at the Lebanese University and Exploring its Correlation With Facebook Relevance: A Questionnaire Study.

Background The prevalence of major depression is particularly high in medical students, affecting around one-third of this population. Moreover, online social media, in particular Facebook, is becoming an intrinsic part in the life of a growing proportion of individuals worldwide. Objective Our primary objective is to identify the prevalence of depression in medical students at the Lebanese University Faculty of Medicine, a unique state university in Lebanon, its correlation with the utilization of the interactive features of Facebook, and the way students may resort to these features. Methods Students of the Lebanese University Faculty of Medicine were assessed for (1) depression and (2) Facebook activity. To screen for major depression, we used the Patient Health Questionnaire-9 (PHQ-9) scale. To test for Facebook activity, we developed the Facebook Resorting Questionnaire (FbRQ), which measures the degree to which students resort to Facebook. Results A total of 365 out of 480 students (76.0%) participated in the survey. A total of 25 students were excluded, hence 340 students were included in the final analysis. Current depression was reported in 117 students out of 340 (34.4%) and t tests showed female predominance. Moreover, PHQ-9 score multiple regression analysis showed that feeling depressed is explained 63.5% of the time by specific independent variables studied from the PHQ-9 and the FbRQ. Depression varied significantly among the different academic years (P<.001) and it peaked in the third-year students. One-way analysis of variance (ANOVA) showed that depression and resorting to Facebook had a positive and significant relationship (P=.003) and the different FbRQ categories had significant differences in resorting-to-Facebook power. The like, add friend, and check-in features students used when resorting to Facebook were significantly associated with depression. Conclusions This study showed that depression was highly prevalent among students of the Faculty of Medicine at the Lebanese University. Moreover, Facebook may be a promising, helpful, psychological tool for optimizing the management of depression. Our study brought to bear further questions that now prompt further observation and scrutiny to know more about the high rates of depression in this student population, more so in the part of the world studied, and to the growing role of social media.

Developing and testing an original Arabic religiosity scale

IntroductionReligion was and still is considered to be a major aspect of life, affecting mental health outcome worldwide and more particularly in the Middle Eastern Arab patients. The aim of this study was to develop an original Arabic religiosity scale and to test its psychometric properties to be used in clinical settings. Patients and methodsThe study was conducted in two steps: (i) development and initial content validation of items through comprehensive literature review and discussion of the existing scales and (ii) distribution of the questionnaire (which included written consent for the participation in this study) among 236 consecutive mental health adult patients consulting at a private clinic, and statistical analysis was performed to test the structure validity, internal consistency, and test–retest reliability. ResultsPrincipal component analysis referred to as factor analysis revealed good structure validity with one-factor solution. Cronbach’s &agr; coefficient (to test internal consistency) was very satisfactory and was found to be 0.85 for the total scale. Test–retest reliability was also high with &kgr; coefficient of 0.77 using the first 20 consecutive patients of the main sample, who were reassessed 2 weeks after the initial administration of the scale. ConclusionThe resulting Arabic religiosity scale is an acceptable, reliable, and valid general measure of religious belief, practice, and importance in the daily life of adult psychiatric patients (including times of difficulties). We hope that this scale will be used widely in Lebanon and the Middle East Arab countries.

Oxytocin and Anxiety Disorders: Translational and Therapeutic Aspects

Purpose of ReviewThis review aims to evaluate the most recent literature examining the oxytocin (OXT) system’s role in human anxiety by surveying various fields of preclinical and clinical research supporting this role, and queries whether the OXT system might be a target for novel anxiolytics.Recent FindingsEvidence from the diverse body of literature presented here, from translational research, genetic and neuroimaging studies, to clinical trials of intranasal (IN) OXT reveals a positive association. In addition, some moderators (e.g., sex, specificities to cues) of OXT’s anxiolytic effects can have an important influence on its outcomes, awaiting further research.SummaryEvidence for the role of OXT in regulating anxiety is undeniable. We expect that the diverse particularities of the OXT system will help broaden our understanding of anxiety and stress-related disorders. We conclude that OXT promises an enticing treatment option for human anxiety disorders especially those associated with socio-emotional dysfunctions.

Depression and Religiosity and their Correlates In Lebanese Breast Cancer Patients

Breast cancer bears considerable morbidity and mortality and is well known to increase the risk of major depression, whereas religiosity has been reported to be protective.

Non-Antidepressant Treatment of Social Anxiety Disorder: A Review

Social anxiety disorder is a debilitating mental illness with eventually serious comorbidities such as major depression and alcohol or substance abuse and dependence. Those comorbidities are much more common when social phobia is left neglected and untreated. It is characterized by excessive fears to one or most social situations (circumscribed versus generalized type). Social phobia has its onset typically in childhood or early adolescence and it is associated with significant functional impairment. Although cognitive behavioral therapy and the selective serotonin reuptake inhibitors are considered the mainstay treatment of this disorder, other psychotropic agents can be of value in the management of this condition. This review discusses the efficacy of beta-bockers, benzodiazepines, anticonvulsants, D-cycloserine, buspirone and atypical antipsychotics in the treatment of social anxiety disorder.

Anticholinergic Use and Misuse in Psychiatry: A Comprehensive andCritical Review

Anticholinergic medications such as Trihexyphenidyl; Biperidine are widely prescribed to prevent or to treat extrapyramidal side effects produced by neuroleptic drugs. Concomitant use of anticholinergic drugs is more common with the first generation antipsychotic medications. There is a considerable body of data suggesting that anticholinergic drugs have a potential of abuse. In this article, we review the psychiatric use, mechanism of action and the abuse of each anticholinergic drug.

Intranasal heroin use – an emerging trend in Lebanon: A single institution study presenting sociodemographic profiles of intranasal versus intravenous users

ABSTRACT Background: High production levels and availability of heroin in Middle East and North African (MENA) countries have been leading to the continuous rise in injecting drug use. On the contrary, in most Western countries, the proportion of heroin injectors may be falling. Interestingly, in Lebanon heroin sniffing has been gaining popularity. We therefore aimed at exploring the characteristics of intranasal heroin use compared to intravenous heroin use in patients admitted to treatment at Skoun, Lebanese Addiction Center. Methods: Between January and September 2013, 186 heroin-dependent users participated in this study: 92 were heroin sniffers and 94 injectors. Data collection was carried out using structured questionnaires on different sociodemographic characteristics and psychological and social functioning. Results: Injectors were significantly younger and had lower levels of employment compared to heroin sniffers. Analysis of health-risk profiles revealed that although injectors were significantly at higher risk of overdose, Hepatitis C infection, and anxiety, sniffers were not risk-free. Other sociodemographic and health-risk profiles did not materialize between the two study groups. Conclusion: The study provides evidence that heroin sniffers share many common characteristics with heroin injectors and therefore do not represent a protected group of heroin users.