Correlates of Homophobic Attitudes in Lebanon: Results of a Cross-Sectional Study.

To assess homophobic attitudes toward gay and lesbian persons and examine how those negative attitudes contributed to risk factors that may impact gay and lesbian persons among a sample of Lebanese individuals. A cross-sectional study, conducted between March and July 2017, enrolled 400 participants aged between 15 and 80 years. 129 (32.3%) of the participants had severe homophobic attitudes. An increase in intense homophobia would significantly increase the odds of emotion focused engagement and decrease the problem focused engagement (Beta = 1.05 and Beta = -1.19, respectively). A stepwise linear regression, using the total homophobia score as the dependent variable showed that knowing someone gay (Beta = -12.97), university education level (Beta = -14.93), high monthly income (Beta = -4.33), and higher problem-focused engagement subscale (Beta = -0.54) would significantly decrease the total homophobic score. Our study supports the prevalence of homophobia among people in Lebanon. Understanding the correlation factors and predict discriminative attitudes can be of great help for policymakers when it comes to approaching the problem of homophobia with evidence-based solutions.

Xenophobic attitudes, behaviors and coping strategies among Lebanese people toward immigrants and refugees.

PURPOSE: To assess the relationship between xenophobia and the coping strategies and evaluate factors associated with xenophobia in Lebanon. DESIGN/METHODS: This cross-sectional study, conducted between March and July 2017, enrolled 433 participants. RESULTS: Severe xenophobia (ß = 1.46) and female sex (ß = 1.45) were associated with higher problem-focused engagement scores. Participants with a low income had lower problem-focused disengagement score compared to those without income. Moderate (ß = 0.80) and intense xenophobia (ß = 1.38) were significantly associated with higher emotion-focused engagement, whereas female sex was significantly associated with lower emotion-focused engagement (ß = -0.71) and disengagement (ß = -0.83). Being divorced compared to single (ß = 2.32) and female sex (ß = 2.04) were associated with higher xenophobia. PRACTICE IMPLICATIONS: Our study supports the prevalence of xenophobia amongst Lebanese but requires a broader assessment of that trend.

Impact of psychosis in bipolar disorder during manic episodes.

OBJECTIVES: To evaluate the effect of psychosis on prognosis as measured by the course of a manic episode, symptoms severity and time to remission and identify existing differences in positive and negative symptoms between psychotic and non-psychotic patients. STUDY DESIGN: 40 bipolar patients presenting with a diagnosis of acute mania were enrolled (18 psychotic patients and 22 non-psychotic patients) in this cross-sectional study. Subjects were required to complete two self-reported questionnaires, the Young Mania Rating Scale (YMRS) for manic symptoms, and Positive and Negative Symptoms Scale (PANSS) for psychotic symptoms. Rating scales were administered at baseline and then again after three weeks of pharmacologic treatment. RESULTS: There were no differences in socio-demographic characteristics between psychotic and non-psychotic subjects. Psychosis was associated with higher scores on the YMRS and PANSS (increased symptoms severity), compared to non-psychotic patients. Both groups demonstrated clinical improvement and remission, with scores amongst psychotic patients remaining higher. Groups were similar in symptomatology except with regards to psychotic symptoms (the content, insight, delusions, hallucinations, grandiosity, poor rapport and unusual thoughts). CONCLUSIONS: Psychosis can be considered a severity index in bipolar disorder, with decreased severity and overall clinical improvement and remission taking place in response to pharmacotherapy.

Naltrexone: A Pan-Addiction Treatment?

Addiction is a major public health problem with few efficacious and safe treatments. The goal of this review is to provide an evidence-based assessment of the therapeutic role of the opioid antagonist naltrexone across the addiction spectrum-substance-based and behavioral. The PubMed database was searched for randomized, placebo-controlled clinical trials that investigated the oral or intramuscular long-acting formulation of naltrexone in substance use disorders or behavioral addictions such as pathological gambling, kleptomania, and trichotillomania. Thirty-nine efficacy studies were retrieved, covering alcohol use disorder (n = 22), opioid use disorder (n = 6), nicotine use disorder (n = 5), stimulant use disorder (n = 2), gambling disorder (n = 2), trichotillomania (n = 1), and kleptomania (n = 1). Despite the very different presentations within and between both addiction categories, the data, as a whole, show consistency in favor of naltrexone's relative efficacy and safety. Given the potential benefit and good tolerability revealed in the studies, the high morbidity associated with addiction, and the dearth of alternate treatments, naltrexone would seem like an underutilized treatment option. Further, naltrexone's seemingly broad anti-addiction efficacy supports a shared role for brain opioid pathways in the pathophysiology of addiction, broadly defined. More studies investigating the efficacy and tolerability of naltrexone and other opioid modulators are warranted. Studies should also further examine the effect of combining psychotherapy with naltrexone, as well as the potential role of naltrexone in treating comorbid addictions.

Cyberbullying: Review of an Old Problem Gone Viral.

PURPOSE: Despite being relatively new, cyberbullying is now well recognized as a serious public health problem affecting children and adolescents. Scientific exploration has lagged media attention, but a synthesis of studies across several disciplines permits an understanding of its epidemiology, phenomenology, mental health dimensions, and management tools. METHODS: To assess current knowledge of cyberbullying, we searched the MEDLINE, PubMed and PsycINFO databases for articles on "cyberbullying" and related designations. The Google search engine was used to capture otherwise unpublished legislative, governmental, and community response data and to help identify relevant books and book chapters. RESULTS: A significant proportion of children and adolescents (20%-40%) have been victims of cyberbullying, with females and sexual minorities seemingly at higher risk. Perpetrators are more likely to be male. By nature of the electronic platform, there seems to be an easier path to the bully-victim phenomenon (victims who become bullies or vice versa) than that in traditional bullying. A nonlinear relationship with age is suggested, but demographic data overall are preliminary. Accompanying psychopathology, including an increasingly well-established link to suicidality, is common. Several prevention and management approaches have been proposed to help prevent cyberbullying or mitigate its effects. DISCUSSION: Cyberbullying's seeming ubiquity, its disproportionate toll on vulnerable populations (e.g., children and sexual minorities), the link with suicidality, and the expected continued rise in Internet penetrance and connectivity make confronting it an urgent matter. A multipronged approach is most likely to succeed and would include: educational media campaigns; school-based programs; parental oversight and involvement; legislative action; and screening and evidence-based interventions by health care providers, especially pediatricians and mental health professionals. CONCLUSIONS: More research is needed into cyberbullying, but available data suggest a serious problem whose consequences are real and should not be dismissed as a "virtual" by-product of an increasingly digitalized childhood and adolescence.

Telemental health: A status update.

A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up-to-date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet-based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better-designed meta-analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis-specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology-mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the "therapeutic alliance", privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology-enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.