Positive and negative correlates of suicidal ideations and behaviors in the emergency department of a university hospital in Beirut: A cross-sectional comparative study.

This study aims to identify the prevalence and correlates of current suicidal ideations and past suicidal behaviors among psychiatric emergencies. A cross-sectional comparative study was conducted using the Ask Suicide Screening Questions (ASQ) as a screening tool that targeted all patients presenting for a psychiatric emergency in a university hospital in Beirut during a four-month period. One hundred and three patients of all age groups have been divided into a group of patients with a positive suicidal screening (n=67, 65%), and another one with a negative suicidal screening (n=36, 35%). Suffering from a personality disorder was found to be a positive correlate of suicide screening (OR: 21.6, 95% CI: 2.6-179.0). Female gender (OR: 4.5, 95% CI: 1.6-13.2) and an elevated number of previous hospitalizations were found to be positive correlates of past suicidal attempts. These correlates should be assessed in the emergency room department (ER) to prevent any subsequent suicidal behavior.

Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study.

PURPOSE: Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio). METHODS: Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively. RESULTS: NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (ß = 0.17; p = 0.027) contributed significantly to NLR variability. CONCLUSION: In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization. LEVEL OF EVIDENCE: III. Evidence obtained from well-designed cohort or case-control analytic studies.

Traumatic life events and its impact on fibromyalgia symptoms through serotonin activity on pain perception and personality traits.

Fibromyalgia is a chronic syndrome characterized by widespread muscular pain and tenderness with no evidence of soft tissue inflammation. Early-life stressors and traumatic events have been described to increase the risk of developing a number of psychiatric conditions, and conditions related to chronic pain in later life such as fibromyalgia on the other hand. In this overview of the literature on the topic, we present the impact that traumatic life events can have on fibromyalgia symptoms through serotonin activity on pain perception and personality traits.

Potential importance of supplementation with zinc for autism spectrum disorder.

Zinc is an essential micronutrient for cellular proliferation and subsequent body and brain development. Zinc deficiency is becoming a major public health issue equally in under-developed and developed countries. The lack of sufficient zinc, whether related to environmental or internal factors, is an important environmental stressor that is eligible to become elucidated as a contributing factor for the pathogenesis of autism spectrum disorder (ASD). The aim of this manuscript is to briefly overview available data regarding the relationship of zinc deficiency with the development of ASD and to relate these data with currently known pathogenetic mechanisms of this disorder namely brain growth disturbances and neuropeptides secretion. Zinc deficiency impacts brain connectivity and growth and alters adequate neurotransmission. In addition, zinc deficiency may indirectly act on the brain by disturbing the immune system and by altering the normal gut-brain connection. Zinc seems to be important for the social effect of neuropeptides. Zinc supplementation in pregnant women and newborn children with the aim of preventing ASD needs further consideration.

Targeting all psychopathological dimensions in the treatment of anorexia nervosa.

Efforts to improve the prognosis of subjects with anorexia nervosa [AN] through the development of specific therapeutic interventions have yielded unsatisfactory results. AN can be perceived as a mental disorder that is clinically composed of disturbed psychopathological dimensions found in major depressive disorder, obsessive compulsive disorder, body dysmorphic disorder, and delusional disorder somatic type. Future treatment strategies of patients with AN might target these multiple psychopathological dimensions. Considering that each of these dimensions is known to be best treated with psychopharmacologic drugs such as antidepressants, mood stabilizers and antipsychotic drugs, AN treatment guidelines may need to consider prescribing them to patients.

"Emotional Chemobrain": A new concept for chemotherapy adverse drug effect?

"Emotional chemobrain" is a new paradigm that relates the occurrence of alterations in the psychological wellbeing of patients to the adverse drug effects of chemotherapy on the neurobiological level. The concept of "emotional chemobrain" is the analogue concept of the classical concept of "chemobrain" but that concerns emotional disturbances related to chemotherapy. Disgust is a negative emotion that might accompany any stressful life event such as having cancer. Increased disgust may lead to the development of mental disorders such as mood and anxiety disorders. Patients with cancer may develop negative emotions such as self-disgust because of their affected autonomy and life style on the one hand and because of chemotherapy's effect on their brain on the other. Self-disgust might be considered as a factor contributing to psychological distress exacerbation in this category of physically ill individuals. In addition to lifestyle modifications and body changes, self-disgust might be exacerbated by chemotherapy in the same way other negative emotions might be exacerbated by this kind of treatment. It might be speculated that the emotional side effects of chemotherapy concern activation modifications in brain regions relevant to emotional elaboration and regulation such as the insular lobe and the amygdala. "Emotional chemobrain" should be considered whenever neuropsychiatric adverse effects of chemotherapy are manifested in patients with cancer. Future studies might be interested in studying the effect of chemotherapy on brain regions that can affect regulation of emotions such as self-disgust.

Improving interoception and self-disgust in the treatment of patients with anorexia nervosa.

Anorexia nervosa (AN) is a mental disorder in which sufficient evidence points towards the presence of a high level of disturbed interoception and self-disgust. High arousal mood induction is a therapeutic technique that helps improve a patient's interoceptive capacities. With some adjustments to this technique such as adding a challenging behavior that induces a "flow" state or a mindfulness component such as in mindful awareness in body-oriented therapy (MABT), it is expected that patients with AN may benefit from an integrative treatment strategy that helps them improve their symptoms of high self-disgust and low interoception.

Estimating the prevalence of autism spectrum disorder in Lebanon.

This cross-sectional survey examines the prevalence rate of Autism spectrum disorder (ASD) in 818 children (16-48 months) across all Lebanese regions. Screening was done using the revised form of the Modified-Checklist for Autism in Toddlers. Based on the total score of items failed, children were classified into 3 categories of ASD risk (low, moderate and high). Phone calls follow-up interviews and clinical assessments for diagnosis ascertainment were conducted. Given the caregivers' reluctance to participate, the prevalence rate was estimated between 49 and 513 per 10,000 with a male predominance. Our prevalence estimation, even under restrictive assumptions, is higher than elsewhere in the Arab region. Anti- stigma interventions adapted to the socio-cultural context are needed prior to future research in the field.

On cognitive debiasing and the judgment of suicide-attackers.

Suicide-attacks are possibly increasing in frequency all over the world. To date, these attacks are not considered as a manifestation of a particular mental illness. However, the process of radicalization of suicide-attackers has to interest the field of mental health. One plausible explanation for the radicalization of individuals is the use of biased cognitive schemes by the indoctrinator. Among these cognitive schemes could figure the causal attribution bias in which the subject cannot distinguish in front of two factors that operate simultaneously, the share of each factor in achieving a certain goal. Another cognitive bias would be the confirmation bias during which the subject would tend to adhere to ideas from his/her own thinking or the thinking of subjects who share some cultural values with him/her and refute any other ideas. Finally, the bias of polarization or splitting could also be incriminated. Through this bias, the subject would either be proud of being a member of a cultural group or ashamed when he/she feels that this group is being attacked and that he/she is unable to rescue it. Approaches to increase the awareness of individuals to the adverse effects of these biased cognitive schemes may theoretically reduce the risk of committing suicide-attacks. However, despite numerous attempts of "deradicalization" involving technological means of communication as well as social "reintegration" centers, all approaches aiming at raising awareness of cognitive biases need to be studied in a scientific manner before they become widespread.

The Relationship between Emotional Intelligence and Nicotine Dependence in Lebanese Adults.

Emotional intelligence (EI) is known to be a risk factor for several types of addiction. The purpose of this study was to investigate, in a cross-sectional design, the presence of a relationship between the level of EI and nicotine dependence in a sample of Lebanese adults. A self-administered questionnaire was used to determine the sociodemographic characteristics, the level of nicotine dependence, and the level of EI in a sample of 142 Lebanese participants from the community. The sample was 51.4% women, with a mean age of 33.9 years. There was no difference in EI level between smokers and non-smokers (p = 0.66), and there were no associations between EI level and the level of nicotine dependence (p = 0.59). However, EI was positively correlated with age (p = 0.023). Due to the fact that smokers have been dependent on nicotine for many years and that EI is known to increase with age, findings suggest that low EI may be a risk factor for initiation, rather than maintenance, of nicotine dependence.

[The effect of methylphenidate on appetite and weight]. / L'effet de la méthylphénidate sur l'appétit et le poids.

OBJECTIVES: To better delineate in the medical literature the effect of methylphenidate on weight and appetite. METHODS: A search on PubMed was carried out for articles published with no restrictions on language or year of publication using the terms: "methylphenidate"; "weight"; "appetite". RESULTS: Methylphenidate increases dopamine and noradrenaline in synapses because of its blockage of the transporters of these monoamines in the frontal cortex and insular lobe. The intracerebral activity of methylphenidate is incriminated in the dysregulation of appetite due to its probable effect stimulating the disgust sensation generated after the activation of the insular lobe by the drug. The anorexigenic effect of methylphenidate has been demonstrated in preclinical studies although the dosage and the administration routes differ in animals from those used for human beings. In clinical studies, methylphenidate decreases the weight of children and adolescents during the first 3 to 6 months after its initiation due to the appetite reduction effect that it generates with a tendency of weight curves to rejoin the curves of subjects who did not receive the treatment a few years after its initiation. CONCLUSION: The anorexigenic effect of methylphenidate does not persist over the long-term in children and adolescents who receive it.

[Prevalence of pathological gambling in Lebanese students]. / Prévalence du jeu pathologique chez les étudiants libanais.

INTRODUCTION: Pathological gambling is a behavioral dependency on hazard games that is classified, in the DSM-IV, among impulse control disorders. According to many studies, the international prevalence of pathological ranges between 2 and 6%. This disorder is often accompanied by a considerable impact on patients' life as well as on the life of people surrounding them. Adolescents and young adults are considered to be a population at risk to develop this kind of behavioral dependency. The problem of pathological gambling is one of the major problems from which the Lebanese population of university students in Lebanese society suffers. The prevalence of pathological gambling in the Lebanese population of university students is lacking from the contemporary medical literature. MATERIALS AND METHODS: In our study, five of the biggest private universities in Lebanon (Notre-Dame University of Louaizé [NDU], Lebanese American University [LAU], American University of Beirut [AUB], Saint-Joseph University [USJ] and Holy Spirit University of Kaslik [USEK]) were surveyed. Each questionnaire was based essentially on the South Oaks Gambling Screen (SOGS). RESULTS: Four hundred and seventy-seven questionnaires were completed in these universities. Among the 477 students that completed the questionnaire, 5.87% appeared to be suffering from pathological gambling; 25.15% of responding students presented some problems related to gambling while the rest of them, corresponding to 68.92%, had no problems related to gambling. CONCLUSION: This is the first study of its kind conducted in the Lebanon. Its interest lies in that it offers an important evaluation of the prevalence of pathological gambling in the Lebanese population of university students. According to this study, the prevalence of pathological gambling in Lebanese university students is high. Prevention programs and sensitization strategies are needed in order to prevent the occurrence of this disorder in the Lebanese young. More studies are needed in this domain in order to evaluate precisely the prevalence of pathological gambling in Lebanese university students.

Methimazole-induced myositis: a case report and review of the literature.

UNLABELLED: Methimazole is an anti-thyroid drug commonly used to treat hyperthyroidism and is a relatively safe medication. Several side effects have been reported and usually develop within 3 months of therapy. Well-known adverse reactions include agranulocytosis, hepatitis, skin eruptions, and musculoskeletal complaints such as myalgia, arthralgia, and arthritis. So far, myositis secondary to carbimazole was described in the context of a lupus-like syndrome or other rare cases of anti-neutrophil cytoplasmic antibodies-associated vasculitis. Methimazole-induced myositis occurring independently of such reactions was rarely stated. We report a patient with hyperthyroidism who, early after therapy with methimazole, developed hepatitis, eosinophilia, and fever that resolved completely after stopping the medication as well as a delayed onset of biopsy-proven eosinophilic myositis and fasciitis of gluteal muscles that resolved eventually without any additional therapy. Therefore, we raise the awareness regarding a rare side effect of methimazole: myositis. LEARNING POINTS: Several differential diagnoses arise when managing a hyperthyroid patient with muscle complaints.Both hyperthyroidism and methimazole are associated with myositis.Methimazole-induced myositis is a rare clinical entity.Resolution of symptoms may occur after stopping methimazole.

[Psychiatric, psychological comorbidities of typical and atypical Charles-Bonnet syndrome]. / Comorbidités psychiatriques et pychologiques du syndrome de Charles-Bonnet typique et atypique.

OBJECTIVES: Charles-Bonnet syndrome (CBS) is conventionally defined by the presence of visual hallucinations in patients suffering from lowered visual acuity without having psychosis or dementia. Actually, it is a syndrome that interests many specialties, especially ophthalmology, geriatrics, neurology and psychiatry. "Atypical CBS" or "CBS plus" was introduced to designate any kind of visual hallucinations that could be considered as a CBS but accompanied by a low level of insight, a possible cognitive decline, other hallucinatory modalities etc. Since all patients suffering from CBS have to be psychiatrically evaluated, psychological and psychiatric implications of their syndrome have to be well understood in order to better manage them. These psychiatric and psychological implications are: the relationship between the CBS and dementia, the psychological reaction of the patients towards their hallucinations and psychiatric comorbidities that could be developed during the course of the syndrome. METHODS: A research via MEDLINE for all the articles published in French or in English between January 1999 and December 2009 was done using the following keywords Charles-Bonnet, psychiatric comorbidities and Charles-Bonnet syndrome, Charles-Bonnet syndrome and dementia, psychological reaction and Charles-Bonnet syndrome. RESULTS: Although some studies report an association between the CBS and dementia, the majority of these studies do not confirm this association and point towards an atypical initial presentation of the syndrome. The psychological reaction accompanying the visual hallucinations of the typical CBS is variable (mild distress, indifference, pleasure). Patients suffering from a typical CBS conserve a full insight during the course of the syndrome. A positive personal psychiatric history or a concomitant psychiatric disorder changes the clinical presentation of the syndrome. DISCUSSION: Our research allowed us to define the following diagnostic criteria for the atypical CBS: 1) diminished level or absence of insight towards the visual hallucinations; 2) presence of a mild cognitive decline; 3) presence of an atypical psychological reaction towards the visual hallucinations as in the case of a severe and prolonged stressful reaction; 4) presence of other hallucinatory modalities; 5) presence of a positive personal psychiatric history or a concomitant psychiatric disorder. Each patient suffering from CBS should be initially evaluated psychiatrically and neurologically in order to confirm or to eliminate the presence of the most common causes of visual hallucinations. In the presence of a lowered visual acuity and a conserved cognitive functioning, the typical CBS is diagnosed after eliminating more common disorders. Once this diagnosis is established, patients should be evaluated in order to rule out the presence of an atypical clinical presentation. CONCLUSION: Atypical CBS is a syndrome that could be eventually associated with dementia, accompanied with a major depressive disorder or another psychiatric disorder, or with vulnerability towards psychiatric disorders. Patients suffering from atypical CBS should be closely followed psychiatrically and neurologically. Patients suffering from the typical CBS should also benefit from a psychiatric follow-up, due to their multiple psychiatric vulnerability factors and their possible management with psychotropic drugs.

Tizanidine for alcohol withdrawal treatment.

The noradrenergic system is an important neurotransmission system implicated in the occurrence of alcohol withdrawal symptoms and anxiety leading to relapse during abstinence from alcohol usage. Tizanidine can play a role in alcohol withdrawal since it interferes with the noradrenergic system neurotransmission. Many noradrenergic system inhibitors in the central nervous system have proven their efficacy in the treatment of alcohol withdrawal syndrome. Imidazoline receptors have been also implicated in the pathophysiology of addiction. Tizanidine is an α2-adrenoreceptor agonist that inhibits noradrenaline release and binds to imidazoline receptors. It is used as an antispastic agent due to its central action on noradrenergic system. Although Tizanidine has been tested as a treatment for opioid withdrawal it has not been tried in alcohol withdrawal yet. A theoretical rationale supports the fact that it can be an efficient treatment for the alcohol withdrawal syndrome as well as for the prevention of relapses.

Eating disorders and schizophrenia in male patients: a review.

OBJECTIVE: To understand the comorbidity of schizophrenia and eating disorders (ED) in male patients. METHOD: A review of the published literature was made via Med- Line using the following terms: "schizophrenia" or "psychosis" in association with "eating disorders", "anorexia nervosa", "binge eating" or "bulimia nervosa", in association with the terms "comorbidity" or "comorbidities" and finally in association with the term "male", "man" or "men". RESULTS: Groups of male patients known to suffer from schizophrenia and screened for ED suffer essentially from anorexia nervosa (0.81%). Groups of male patients screened for anorexia nervosa and then for schizophrenia demonstrate high comorbidity prevalence (36%). In general, ED symptoms diminish with psychotic episodes and recur when the psychotic episode remits. A man with an ED has a 3.6 times more risk than a woman with an ED to have comorbid schizophrenia. In men, ED present atypical features so that ED not otherwise specified (EDNOS) is relatively frequent. DISCUSSION AND CONCLUSION: Male patients described in the literature as suffering from schizophrenia and ED fall under one of four categories: a) acute psychotic episode related to organic causes due to malnutrition; b) male patients presenting with an ED who later develops schizophrenia; c) male patients known to suffer from schizophrenia and who develops distorted eating cognitions and disordered behaviors; d) male patients suffering from schizophrenia and developing a medication-induced ED.