Gender differences and risk factors for smoking among patients with various psychiatric disorders in Saudi Arabia: a cross-sectional study.

BACKGROUND: The higher prevalence of smoking among psychiatric patients is well established. However, gender-specific associations have rarely been the focus of studies among patients with various psychiatric disorders. The aim of this study was to estimate the gender-specific prevalence of current smoking by psychiatric patients and its association with various psychiatric disorders and the use of psychotropic medications. METHODS: A cross-sectional observational study was performed between July 2012 and June 2014. Patients were recruited from six hospitals located in the five regions of Saudi Arabia. RESULTS: Of the 1193 patients, 402 (33.7%) were current smokers. The incidence of current smoking was much higher among males than females (58.3% versus 6.7%, p < 0.001). In one or both genders, current smoking was associated with marital status, education, family income, residence, obesity, physical activity, substance abuse, inpatient status, previous psychiatric hospitalization, and age at onset of psychiatric illness. In both gender, smoking was higher in patients who had a secondary psychiatric disorder (66.7% versus 37.5%, respectively), those who had a primary psychotic disorder (63.7% versus 12.3%), and those taking antipsychotic medication (64.1% versus 8.3%) but lower in patients who had a primary depressive disorder (40.3% versus 4.3%), those who had a primary anxiety disorder (45.8% versus 0.0%), and those taking antidepressant medications (53.7% versus 3.6%). In a multivariate analysis adjusted for demographic/clinical characteristics and psychiatric disorders, current smoking was independently associated with primary psychotic disorders in females (OR = 3.47, 1.45-8.27, p = 0.005) but not in males. In a multivariate analysis adjusted for demographic/clinical characteristics and psychotropic medications, current smoking was independently associated with antipsychotic medication use in males (OR = 1.79, 1.10-2.93, p = 0.020). Current smoking was strongly associated with substance abuse in both univariate and multivariate analyses. CONCLUSION: The prevalence of current smoking is high with marked gender difference in a large sample of mixed psychiatric patients in Saudi Arabia. Smoking-cessation programs may be urgently needed for these vulnerable patients.

Prevalence and determinants of physical activity in a mixed sample of psychiatric patients in Saudi Arabia.

OBJECTIVES: To estimate prevalence of physical activity and its associations with various psychiatric disorders and the use of psychotropic medications. METHODS: A cross-sectional observational study was carried out between July 2012 and June 2014. Patients were enrolled from a number of hospitals located in 5 regions of the Kingdom of Saudi Arabia. RESULTS: A total of 1185 patients were included in current analysis: 796 were outpatients, and 389 were inpatients. Out of 1,185 patients, 153 (12.9%) were physically active. Much higher rates of physical activity were reported among males than females (15.9% versus 9.6%, p less than 0.001). According to the univariate analysis, higher rates of physical activity were positively correlated with primary bipolar disorders, the use of antianxiety medications and, to a lesser extent, use of antipsychotic medications, but they were negatively correlated with primary anxiety disorders, use of antidepressant medications, and use of multiple psychotropic medications. The associations between physical activity and primary bipolar disorders (odds ratio [OR]=2.47, p=0.002), use of antianxiety medications (OR=3.58, p=0.003), and use of multiple psychotropic medications (OR=0.33, p less than 0.001) remained significant after adjusting for demographic and clinical characteristics. CONCLUSION: We report a variable but generally low prevalence of physical activity among a large, mixed sample of psychiatric patients in Saudi Arabia. These findings may highlight the importance of assessing physical activity status of psychiatric patients and the critical need for physical activity promotion programs among this group of disadvantaged patients.

Prevalence and risk factors of hyperprolactinemia among patients with various psychiatric diagnoses and medications.

OBJECTIVES: Hyperprolactinemia is a common adverse event associated with psychotropic medications (mainly antipsychotics) used in the management of schizophrenia and bipolar disorders. The aim of this study was to estimate the prevalence of hyperprolactinemia in psychiatric patients and to evaluate its association with various psychiatric diagnoses and the use of various psychotropic medications. METHODS: A cross-sectional observational study was conducted between July 2012 and June 2014. Patients were recruited from a number of hospitals located in the five regions of Saudi Arabia. Hyperprolactinemia was defined as blood prolactin levels >25 ng/mL in females and >20 ng/mL in males, regardless of the presence of symptoms. RESULTS: A total of 997 patients (553 males and 444 females) were included in the current analysis. The average blood prolactin level was 32.6 ± 44.1 ng/mL, with higher levels among females than males (42.9 ± 61.3 versus 24.4 ± 18.6, p < .001). The prevalence of hyperprolactinemia was 44.3%, with no significant gender difference (41.9% in females versus 46.3% in males, p = .164) but with huge variability according to individual antipsychotic and other psychotropic medications. In the multivariate analysis adjusted for demographic and clinical characteristics, hyperprolactinemia was independently and positively associated with using antipsychotic medications (OR = 2.08, 1.26-3.42, p = .004). Additionally, previous hospitalisation, diabetes and hypothyroidism were positively associated, whereas having primary depressive disorders was negatively associated. CONCLUSIONS: We report a high prevalence of hyperprolactinemia among a large sample of psychiatric patients in Saudi Arabia, which was linked to the use of antipsychotic medications. Routine measurement of blood prolactin levels for all patients maintained on antipsychotic agents is recommended, regardless of symptoms.

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

Abstract Objective This study aimed to explore the current patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia. Methods Cross-sectional study was conducted on patients seeking psychiatric advice at six hospitals in the five main regions of Saudi Arabia. The data were primarily obtained by reviewing patient charts. Results Total of 1,205 patients were recruited. The majority was unemployed (71.4%), had a low level of education (85.5%), and had low income (61.9%). The most common psychiatric diagnoses among inpatients were schizophrenia (55.8%), bipolar disorder (23.3%) and major depressive disorder (7.2%). The most common psychiatric diagnoses among outpatients were major depressive disorder (29.3%), schizophrenia (28.9%), generalized anxiety disorder (15.6%) and bipolar disorder (11.5%). Primary psychotic disorders and secondary psychiatric disorders were significantly more frequent among men whereas primary bipolar disorders and depressive disorders were significantly more frequent among women in both inpatient and outpatient settings. Psychotic and bipolar disorders were significantly more frequent among younger patients whereas depressive disorders were significantly more frequent among older patients; anxiety disorders were of similar frequency in all age groups. Discussion The most common psychiatric diagnoses among inpatients were schizophrenia and bipolar disorder whereas the most common psychiatric diagnoses among outpatients were major depressive disorder and schizophrenia.

Prevalence of metabolic syndrome and its components among patients with various psychiatric diagnoses and treatments: A cross-sectional study.

OBJECTIVES: To evaluate the prevalence and clinical correlates of metabolic syndrome (MetS) and its components among patients with psychiatric disorders. METHODS: A cross-sectional study was conducted among adult patients with psychiatric disorders at major hospitals in Saudi Arabia. After measurements were recorded for all MetS components, demographic and clinical information was obtained mainly by reviewing the patients' medical charts. RESULTS: The prevalence rate of MetS among the 992 study participants was 41.2%, high triglycerides was 32.8%, large waist circumference was 42.2%, high blood pressure was 42.5%, high fasting blood sugar was 47.8%, and low HDL cholesterol was 52.5%. Participants with MetS were more likely to be older, illiterate, divorced or widowed, have a higher number of children, older age of onset of psychiatric illness, longer duration of psychiatric disease, no previous psychiatric hospitalization, and have a history of diabetes and hypertension. After adjusting for significant demographic and clinical characteristics, none of the psychiatric diagnoses and treatments was independently associated with MetS, except the use of mirtazapine and venlafaxine. CONCLUSIONS: The prevalence of MetS and its components among patients with psychiatric disorders is alarming irrespective of their diagnoses. Thus, metabolic screening especially among high risk groups is critical.

Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia.

OBJECTIVE: To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia. METHOD: This cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651) and female (n=594) patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient's type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients. RESULTS: Several studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004), unmarried (P<0.001), have less number of children (1-3; P=0.002), unemployed (P=0.001), have a lower family income (<3,000 SR; P<0.001), live in rural communities (P<0.001), have a lower body mass index (P=0.001), and are smokers (P<0.001); however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%), antidepressants (41.4%), mood stabilizers (27.9%), and antianxiety (6.2%). However, compared to outpatients, the current use of medications for inpatients was more frequent (93.8% vs 89.9%, P=0.019) with inpatients more likely to be treated with multiple medications (2.1 vs 1.8 medications). A similar trend was observed in the case of antipsychotics, high potency first-generation antipsychotics, second-generation antipsychotics, mood stabilizers, and antianxiety medicines where inpatients were more frequently treated with these medications for all psychiatric diagnoses when compared with outpatients. On the contrary, in the case of antidepressant treatment, an opposite trend was observed with more number of treated outpatients in comparison to inpatients. Among elderly patients, 75.9% received antipsychotics, mainly second-generation formulations (67.2%), whereas only 41% received antidepressants and 13.8% received mood stabilizers. CONCLUSION: Based upon the present study data, it is concluded that among all the psychotropic medications, antipsychotics were heavily used and the frequency was found to be significantly high in the case of inpatients compared with outpatients. Such a practice may lead to multiple negative consequences among the Saudi psychiatric patient population. Further, extensive use of sodium valproate in the case of bipolar disorder, and also among females either in childbearing age or during pregnancy is also the cause of concern and warrants logical use. Overall, this study may help in assessing the burden of psychiatric illness within specific patient demographics and might be effectively used to strategically plan health resources allocation, generate new treatment hypothesis, or be used as a source of evidence that could further integrate other observational studies.