Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh.

Traditional practices constituting spiritual and religious (S/R) healing are an important component of the holistic healthcare model and are used in health, well-being, and treating a variety of diseases around the world. The main focus of this review is to summarize the Complementary and Alternative Medicine (CAM) studies that especially target S/R healing practices in Saudi Arabia (SA) and discuss the results in light of relevant international literature. From year 2013-2017, electronic searches of PubMed, OvidSP, Google Scholar, and two publishing housing Web sites (Sciencedomain.com and Dove Medical Press.com) were made using key words and Boolean operators and retrieved thousands of published papers from peer-reviewed journals. Two independent reviewers decided to include a total of 108 articles: 48 from SA and 60 from other international literature. The sociodemographic variables of the participants varied in local studies and were comparable with international data. The frequency and types of religious and spiritual practices reported in local and international zones varied in accordance with religious belief, gender, age, education, and prevalent chronic diseases. Most of professionals and practitioners showed fairly good knowledge and positive attitude toward spiritual and religious practices used in diverse clinical and non-clinical situations across the world. Furthermore, it was observed that in the international scenario, S/R researches using specific religious screening tools have been conducted on different aspects of clinical application including self-care, social cohesion, negative impact, and child development, whereas regional studies targeting varied participants mainly focused on the epidemiological trends of S/R therapies in Saudi Arabia. CAM practitioners and public tend to show great interest in prescribed and self-use of religious and spiritual therapies across the world because of multiple dynamic forces, including positive effects on health, sense of well-being and disease control, cost-effectiveness, easy access to services, and improvement in quality of life. Further studies are needed to assess the effectiveness of different types of religious and spiritual therapies and practices used in specific diseases, their role in promotion of health and well-being, and prevention of diseases nationwide and across the world. Besides integration of S/R into mainstream treatment modalities, medical education curriculum, continuous medical education, and training programs are needed for bridging the knowledge, attitude, and practice gaps concerning CAM in targeted population groups such as medical professionals, CAM practitioners, medical students, public and traditional healers, not only in SA but also around the world.

The medical perspective of cupping therapy: Effects and mechanisms of action.

Cupping Therapy (CT) is an ancient method and currently used in the treatment of a broad range of medical conditions. Nonetheless the mechanism of action of (CT) is not fully understood. This review aimed to identify possible mechanisms of action of (CT) from modern medicine perspective and offer possible explanations of its effects. English literature in PubMed, Cochrane Library and Google Scholar was searched using key words. Only 223 articles identified, 149 records screened, and 74 articles excluded for irrelevancy. Only 75 full-text articles were assessed for eligibility, included studies in this review were 64. Six theories have been suggested to explain the effects produced by cupping therapy. Pain reduction and changes in biomechanical properties of the skin could be explained by "Pain-Gate Theory", "Diffuse Noxious Inhibitory Controls" and "Reflex zone theory". Muscle relaxation, changes in local tissue structures and increase in blood circulation might be explained by "Nitric Oxide theory". Immunological effects and hormonal adjustments might be attributed to "Activation of immune system theory". Releasing of toxins and removal of wastes and heavy metals might be explained by "Blood Detoxification Theory". These theories may overlap or work interchangeably to produce various therapeutic effects in specific ailments and diseases. Apparently, no single theory exists to explain the whole effects of cupping. Further researches are needed to support or refute the aforesaid theories, and also develop innovative conceptualizations of (CT) in future.

History of cupping (Hijama): a narrative review of literature.

Cupping (Hijama in Arabic) is an ancient, holistic method for the treatment of a variety of diseases. Though the exact origin of cupping therapy is a matter of controversy, its use has been documented in early Egyptian and Chinese medical practices. Diverse human civilizations have contributed to the historical development and continuation of cupping therapy. This narrative review describes the history of cupping, historical definitions, cupping instruments and uses of cupping therapy. Electronic searches of relevant databases (PubMed, Google Scholar and OvidSP) were conducted using keywords and Boolean operators. Manual searches and references of published articles and books were also conducted. A number of articles (N = 625) were retained for extensive review, and finally 83 articles were included in this paper. The historical descriptions of cupping therapy were found in ancient human civilizations of the Eastern and Western world. There were inconsistent data concerning the origin of cupping, definitions, instruments, procedures, definite advancements and research in Hijama over centuries. Cupping therapy fell out of favor in 17th and mid-18th centuries but recovered popularity in modern medicine. Currently, cupping therapy is used for health promotion, prophylaxis and treatment of a variety of diseases around the world. Cupping therapy with a good safety profile has a checkered history and is a well-recognized traditional method for managing medical conditions. Currently, the scope of cupping therapy is expanding, and a growing body of research is providing additional evidence-based data for the further advancement of cupping therapy in the treatment of a variety of diseases.

Knowledge, attitude and practice of patients with type 2 diabetes mellitus towards complementary and alternative medicine.

OBJECTIVE: The use of complementary and alternative medicine (CAM) is relatively common among patients with type 2 diabetes mellitus (T2DM) around the world. Like many other countries, Saudi Arabia has a high incidence of T2DM, and incorporates the use of CAM in its treatment. This study explores the knowledge, attitude and practice (KAP) of CAM therapies among patients with T2DM and explores the relationships between sociodemographics and the KAP of CAM modalities. METHODS: This is a hospital-based, observational, cross-sectional study that selected 302 outpatients with T2DM, from Diabetic Center of King Salman bin Abdul-Aziz Hospital, in Riyadh city, in May 2014. Patients were interviewed using a predesigned questionnaire. RESULTS: The mean age of patients was (51.6 ± 10.6) years and 43.4% of them were males. The prevalence of CAM practices was 30.5%; 30.39% of them used herbs, 20.58% used wet cupping and 17.64% used nutritional supplements and other therapies. The factors found to predict the use of CAM therapies among patients with T2DM were: age above 51 years, unemployment and the participants± knowledge about the effectiveness of CAM products. CONCLUSION: This preliminary study estimated the prevalence of CAM use, revealed positive attitude towards CAM and found three significant predictors of CAM use among patients with T2DM, which is consistent with regional data. A community-based research with a larger sample that targets T2DM population is needed in Saudi Arabia.

Medical students' knowledge, attitude, and practice of complementary and alternative medicine: a pre-and post-exposure survey in Majmaah University, Saudi Arabia.

BACKGROUND: Evidently, complementary and alternative medicine (CAM) is a recognized medical practice that efficiently uses multiple treatment therapies and techniques in the prevention and management of a variety of human disorders. Many medical schools have integrated CAM curriculum in medical education system worldwide. Research in knowledge, attitude, and practice (KAP) of diverse health professionals exposed to CAM courses is important from many perspectives including improvement in KAP and teaching skills of faculty, together with capacity building and curriculum development. OBJECTIVE AND SETTING: This pre- and post-design cross-sectional study aimed to assess CAM-KAP of two intakes of medical students in Majmaah University, Saudi Arabia. METHODS: The second-year medical students of the first (year 2012-2013) and second (year 2013-2014) intake (n=26 and 39, respectively) were selected for this study. A reliable, 16-item self-administered questionnaire was distributed among all the students for answering before and after the 48-hour CAM course. The data were analyzed using appropriate statistical test of significance. RESULTS: Medical students' knowledge and attitude toward CAM significantly improved across some subitems of CAM questionnaire with a positive trend in the rest of its items including their views on CAM practices. CONCLUSION: CAM course tends to have a positive impact on KAP of medical students. The preliminary results of this study call for further research with a larger sample in academic settings across the nation.

Mental health system in Saudi Arabia: an overview.

BACKGROUND: There is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia. OBJECTIVE: We overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement. METHOD: The World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009-2010, 4 years after a baseline assessment. RESULTS: Several mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society. CONCLUSION: This updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience.

Mood disorders and complementary and alternative medicine: a literature review.

Mood disorders are a major public health problem and are associated with considerable burden of disease, suicides, physical comorbidities, high economic costs, and poor quality of life. Approximately 30%-40% of patients with major depression have only a partial response to available pharmacological and psychotherapeutic interventions. Complementary and alternative medicine (CAM) has been used either alone or in combination with conventional therapies in patients with mood disorders. This review of the literature examines evidence-based data on the use of CAM in mood disorders. A search of the PubMed, Medline, Google Scholar, and Quertile databases using keywords was conducted, and relevant articles published in the English language in the peer-reviewed journals over the past two decades were retrieved. Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders. Clinical trials of vitamin B complex, vitamin D, and methylfolate found that, while these were useful in physical illness, results were equivocal in patients with mood disorders. Studies support the adjunctive role of omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid in unipolar and bipolar depression, although manic symptoms are not affected and higher doses are required in patients with resistant bipolar depression and rapid cycling. Omega-3 fatty acids are useful in pregnant women with major depression, and have no adverse effects on the fetus. Choline, inositol, 5-hydroxy-L-tryptophan, and N-acetylcysteine are effective adjuncts in bipolar patients. Dehydroepiandrosterone is effective both in bipolar depression and depression in the setting of comorbid physical disease, although doses should be titrated to avoid adverse effects. Ayurvedic and homeopathic therapies have the potential to improve symptoms of depression, although larger controlled trials are needed. Mind-body-spirit and integrative medicine approaches can be used effectively in mild to moderate depression and in treatment-resistant depression. Currently, although CAM therapies are not the primary treatment of mood disorders, level 1 evidence could emerge in the future showing that such treatments are effective.

Neuromodulation therapies and treatment-resistant depression.

BACKGROUND: Patients with treatment-resistant depression (TRD) who showed partial response to pharmacological and psychotherapeutic interventions need a trial of neuromodulation therapies (NTs). OBJECTIVE: This paper aims to review evidence-based data on the use of NTs in TRD. METHOD: Using keywords and combined-word strategy, multiple computer searches of PubMed, Google Scholar, Quertle(R), and Medline were conducted for retrieving relevant articles published in English-language peer-reviewed journals (2000-2012). Those papers that addressed NTs in TRD were retained for extensive review. RESULTS: Despite methodological challenges, a range of 30%-93% of TRD patients showed substantial improvement to one of the NTs. One hundred-percent improvement was reported in two single-case studies on deep brain stimulation. Some studies reported no benefits from transcranial direct current stimulation. NTs were reported to have good clinical efficacy, better safety margin, and benign side-effect profile. Data are limited regarding randomized clinical trials, long-term efficacy, and cost-effectiveness of these approaches. Both modified electroconvulsive therapy and magnetic seizure therapy were associated with reversible but disturbing neurocognitive adverse effects. Besides clinical utility, NTs including approaches on the horizon may unlock the biological basis underlying mood disorders including TRD. CONCLUSION: NTs are promising in patients with TRD, as the majority of them show good clinical response measured by standardized depression scales. NTs need further technological refinements and optimization together with continuing well-designed studies that recruit larger numbers of participants with TRD.

Impact of pharmacist interventions on patients' adherence to antidepressants and patient-reported outcomes: a systematic review.

BACKGROUND: Pharmacist intervention in improving patient adherence to antidepressants is coupled with better outcomes. AIMS: The aim of this investigation was to systematically examine the published literature to explore different types of pharmacist interventions used for enhancing patient adherence to antidepressant medications. Three specific questions guided the review: what is the impact of pharmacist interventions on adherence to antidepressant medication? What is the impact of pharmacist interventions on patient-reported outcomes and patient satisfactions? What are the types of interventions used by pharmacists to enhance patients' adherence to antidepressants? SEARCH STRATEGIES: A systematic review of the literature was conducted during August-November 2010 using PubMed, BIOSIS Previews(®) Web of Science, ScienceDirect, the Cochrane Library, PsycINFO(®), IngentaConnect™, Cambridge Journals Online, and Medscape databases. Key text words and medical subject headings included pharmacist intervention, medication intervention, depression, medication adherence, health-related quality of life, patient-reported outcomes, and antidepressants. RESULTS: A total of 119 peer-reviewed papers were retrieved; 94 were excluded on the basis of abstract review and 13 after full-text analysis, resulting in twelve studies suitable for inclusion and intensive review. The most common intervention strategy that pharmacists utilized was a combination of patient education and drug monitoring. A cumulative patient adherence improvement in this review ranged from 15% to 27% attributed to utilization of different interventions and different combinations of interventions together with patient satisfaction with the treatment when depression improved. CONCLUSION: This review suggests that pharmacist intervention is effective in the improvement of patient adherence to antidepressants. This may be a basis for more studies examining the effectiveness of innovative interventions by pharmacists to enhance patient adherence to antidepressant medications.

Suicidal and self-injurious behavior among patients with alcohol and drug abuse.

BACKGROUND: Self-injurious behavior, a major public health problem globally, is linked with alcohol and drug abuse. This cross-sectional study aimed to identify the prevalence and correlates of self-harming behavior in patients with alcohol or drug abuse problems. METHODS: This was a one-year study that recruited a convenience sample of 736 outpatients and inpatients identified with alcohol or drug abuse, and was conducted at Al-Amal mental health hospitals in three major cities. All consecutively selected patients were interviewed on five working days for data collection on a semistructured sociodemographic form using the Columbia Suicide Severity Rating Scale Risk Assessment version. RESULTS: In addition to the socioclinical profile revealed, 50.7% of respondents reported any suicidal ideation, while 6.9% reported self-injurious behavior without intent to die. Any suicidal and self-injurious behavior was reported by 13.1% of participants. A total of 71.3% of respondents reported any recent negative activating events. In addition to any treatment history, observed correlates were hopelessness (60.7%), perceived burden on family (29.5%), refusing a safety plan (26.1%), and sexual abuse (11%). Conversely, reasons for living (64.9%), fear of death or dying due to pain and suffering (64.3%), and spirituality (92%) were largely endorsed as protective factors. There were multiple significant odds ratios (P ≤ 0.01) revealed when independent socioclinical variables were compared with dependent variables in terms of suspected risk and protective factors. In an adjusted logistic regression model, none of the independent variables contributed significantly to any suicidal and self-injurious behavior, any suicidal ideation, or protection from them (P > 0.05). CONCLUSION: Our preliminary results suggest that there are some socioclinical correlates of any suicide ideation, suicidal and self-injurious behavior, and protection from risky behavior, but which of them contributes significantly to the risk and protective dimensions is yet to be elucidated in prospective community-based studies with larger and more diverse samples.

The Global Youth Tobacco Survey: 2001-2002 in Riyadh region, the Kingdom of Saudi Arabia.

BACKGROUND: Tobacco use is a major public health problem, and its prevalence is globally increasing, especially among children and adolescents. OBJECTIVE: The Global Youth Tobacco Survey aimed to explore the epidemiological trends and risk factors of tobacco smoking among intermediate school boys in Riyadh region of the Kingdom of Saudi Arabia. METHOD: A two-stage cluster sample design was used to produce a representative sample of male students from selected schools. The participants (n = 1830) self recorded their responses on the Global Youth Tobacco Survey questionnaire. RESULTS: Lifetime prevalence of cigarette smoking was 35%, while 13% of students currently used other tobacco products. About 16% of students currently smoked at home, and 84% of students bought cigarettes without any refusal from storekeepers. Thirty-one percent and 39% of students were exposed to secondhand tobacco smoke inside and outside the house, respectively, which was definitely or probably harmful to health as opined by 87% of participants, and 74% voiced to ban smoking from public places. Among current smokers, 69% intended (without attempt) to quit and 63% attempted (but failed) to quit during the past year. Almost an equal number of students saw antismoking and prosmoking media messages in the last month, and 28% of students were offered free cigarettes by a tobacco company representative. In schools, more than 50% of students were taught about the dangers of cigarette smoking in the last year. Smoking by parents, older brothers, and close friends, watching prosmoking cigarette advertisements, free offer of cigarettes by tobacco company representatives, perception of smoking being not harmful, and continuing smoking which can be easily quit significantly increased the odds of smoking by students. CONCLUSION: The common use of tobacco in school populations needs to be addressed by, among other tobacco control measures, a strict ban on cigarette selling to minors and intensive regular tobacco control campaigns involving health and religious messages.

Effectiveness of a training programme for primary care physicians directed at the enhancement of their psychiatric knowledge in Saudi Arabia.

OBJECTIVE: A substantial number of patients with psychiatric disorders consult primary care physicians for comprehensive health care; however, the diagnosis and effective treatment of psychiatric disorders are deficient in primary health care. The aim of this intervention study is to assess the pre- and post-psychiatric training knowledge of primary care physicians. METHOD: The setting of this study was Buraidah Mental Health Hospital. The research design consisted of a pre- and post-test comparison of physicians' responses (n = 70) with a control group (n = 40). The instrument includes a Knowledge Test comprised of 50 questions on primary care psychiatry. RESULTS: There were no significant differences between the intervention and control groups with regard to several confounding sociodemographic variables, but physicians' age and duration of medical practice were significantly higher in the control group. There were significant differences between knowledge of intervention and controls prior to psychiatric training and this difference was further highly significant post-psychiatric training. The gain in knowledge of intervention group post-psychiatric training was highly significant as compared to pre-test knowledge but there was no difference in the knowledge of the control group. CONCLUSION: Psychiatric training courses can enhance physicians' knowledge in clinical psychiatry with possible psychiatric implications, including early diagnosis and better treatment of primary care patients with psychiatric problems.

Making psychiatric sense of sand: a case of delusional disorder in Saudi Arabia.

Somatic delusional disorder is an uncommon psychiatric disorder that has been typically reported in elderly women. This article reviews the literature and describes a Saudi female patient who presented with novel somatic delusion of turabosis--the conviction that she was continually being covered by sand from sandstorms. Although the systematized delusional convictions remained unshakable, her anxiety and mood symptoms responded to a regimen of tricyclic antidepressants and her delusional beliefs resolved within eight weeks of treatment with risperidone. Sociocultural themes and therapeutic approaches to somatic delusional disorder are discussed.

Curriculum framework for a master's degree in community medicine: some reflections with reference to Saudi Arabia

This paper describes a skeleton of a new curriculum intended for the teaching of community medicine leading to a recognized master's degree. The curriculum should have a detailed course framework and a distinctive rationale and justification with aims and specific objectives, contents, teaching methods, proper evaluation, available resources, and a well defined time framework. It is a prerequisite to develop a comprehensive curriculum before any postgraduate course is started. This curriculum must address all the relevant issues outlined in this paper. The authors recommend that the semitheoretical construction of the curriculum could be utilized in Saudi Arabia or possibly elsewhere with appropriate modifications