A study of postpartum depression and maternal risk factors in Qatar.

OBJECTIVE: The objective of this study was to investigate the association between maternal complications and postpartum depression (PPD) among postpartum women in Qatar by using the Edinburgh Postnatal Depression Scale (EPDS) as well as a structured questionnaire. METHODS: This is a cross-sectional study of PPD of 1379 postpartum women within 6 months of delivery attending the primary healthcare centers of the State of Qatar. RESULTS: The prevalence of PPD was 17.6% in the studied mothers. The results of the logistic regression analysis showed that the risk factors for PPD included various socio-demographic risk factors such as education, occupation, consanguinity and access to transportation. Amongst the maternal factors studied, history of unplanned pregnancy and infertility and other medical complications such as gestational diabetes, heart disease, threatened abortion and cesarean section were found to be risk factors for PPD. Amongst the postpartum women with maternal complications, items related to feeling scared and panicky and feeling sad and miserable were the most frequently reported symptoms of depression. These women were also more likely to be experiencing sleep difficulty (p = 0.029) compared to women without maternal complications. CONCLUSION: While socio-demographic risk factors are well studied in the PPD literature, there is much less information on the impact of maternal complications on the psychological status of postpartum women. Postpartum women, especially those with maternal complications, need close screening and have quick access to mental healthcare within integrated reproductive health services.

Influence of clerkship on attitudes of medical students toward psychiatry across cultures: United States and Qatar.

OBJECTIVE: To assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries. METHODS: A group of 74 students from Weill Cornell Medical College-New York and 32 from Weill Cornell Medical College-Qatar completed pre- and post-clerkship questionnaires assessing their attitudes toward psychiatry. RESULTS: On the pretest, the Qatar students had less positive attitudes than the New York students, as evidenced by lower group mean total scores. During the clerkship, the attitudes of students at both schools improved, but more markedly in Qatar, narrowing the group differences. CONCLUSION: A psychiatry clerkship with a U.S.-derived curriculum had a positive effect on medical students' attitudes toward psychiatry in Qatar, suggesting the usefulness of applying such curricula across cultures.

Perceptions of boundaries and cultural influences in Qatar.

BACKGROUND: Boundary issues, which regularly arise in therapy, can present dilemmas for most clinicians. There has been substantial literature on boundary excursions in clinician-patient relationships, however, very little empirical research exists and is documented. As mental health researchers, we need to investigate a wide range of sensitive topics to enhance our understanding of the many issues that arise in the psychotherapeutic frame. AIMS: We set out to empirically explore perceptions of what may constitute a boundary violation among the mental health staff in the State of Qatar and their views on the subject. RESULTS: A total of 50 participants (24 psychiatrists, 2 doctorate level psychologists, 24 psychiatric nurses) responded with a response rate of 80%. Participants rated each possible boundary violation according to its degree of harm and professional unacceptability. Three distinct groupings of boundary violations were obtained: (1) core, consisting of the most serious violations; (2) disclosure and greeting behaviour, involving disclosure of information about the therapist and greeting behaviour; and (3) separation of therapist and client lives, involving encounters between therapists and clients outside of therapy. CONCLUSIONS: It is important to ascertain these dilemmas so that these theoretical models can be integrated in clinical practice.

Differences and similarities in cross-cultural perceptions of boundaries: a comparison of results from two studies.

There has been substantial literature on boundary excursions in clinician-patient relationships; however, very little empirical research exists. Even less information exists on how perceptions of this issue might differ across cultures. Prior to this study, empirical data on various kinds of boundary excursions were collected in different cultural contexts. First, clinicians from the U.S. and Brazil were asked to rate 173 boundary excursions for both their perceived harmfulness and their professional unacceptability (Miller et al., 2006). In a second study, colleagues from Qatar administered a slightly modified version to mental health care professional staff of a hospital in Doha, Qatar (Ghuloum et al., 2011). In this paper, the results of these two separate studies are compared. The results showed some similarities and some differences in perceptions of the boundary behaviors. For example, both sets of cultures seem to agree that certain behaviors are seriously harmful and/or professionally unacceptable. These behaviors include some frankly sexual behavior, such as having sexual intercourse with a patient, as well as behavior related to doing business with the patient, and some disclosing behavior. There are also significant cultural differences in perceptions of how harmful some of the behaviors are. Qatari practitioners seemed to rate certain behaviors that within therapy mix disclosing or personal behavior with therapy as more harmful, but behaviors that involved interacting with patients outside of therapy as less serious. A factor analysis suggested that participants in U.S./Brazil saw a much larger number of behaviors as making up a set of Core Boundary Violations, whereas Qatari respondents separated sexual behaviors from others. Finally, a Rasch analysis showed that both cultures perceived a continuum of boundary behaviors, from those that are least harmful or unprofessional to those that are highly harmful or unprofessional. One interpretation is that cultural factors may be most influential on those kinds of behaviors that are perceived as relatively less serious. Implications for training and supervision are also discussed.

A study of postpartum depression in a fast developing country: prevalence and related factors.

BACKGROUND: Depression is a common and disabling complication of postpartum women. There is a paucity of research on postpartum depressive disorders and their predictors in women from Arab countries. AIM: The aim of this study was to determine the prevalence and identify risk factors of postpartum depression among Arab women in Qatar using Edinburgh Postnatal Depression Scale Score (EPDS). DESIGN: This is a prospective cross-sectional study conducted during the period from January 2010 to May 2011. SETTING: Primary healthcare centers of the Supreme Council of Health, State of Qatar. SUBJECTS: A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study. METHODS: The study was based on a face-to-face interview with a designed diagnostic screening questionnaire. Occurrence of postpartum depressive symptoms was assessed by the EPDS. Also, socio-demographic characteristics, medical and family history, and obstetric variables of patients were collected through a designed questionnaire. The diagnostic screening questionnaire was reviewed and calculated the final score which identified the risk cases. RESULTS: The prevalence of postpartum depression among the study sample was 17.6%. Mothers of age above 35 years (49.9% vs. 39.2%; p < 0 .001), low education below intermediate level (51% vs. 35.8%; p < 0.001), housewives (38.7% vs. 29%; p = 0.03), with low monthly income (QR 5000-9999) (43.2% vs. 32.2%; p < 0.001) were significantly at high risk for postpartum depression. Maternal complications (38.7% vs. 26.1%; p < 0.001) and caesarean section (36.2% vs. 28.8%; p = 0.022) were significantly higher among depressed mothers compared to non-depressed women. Financial difficulties (OR = 2.04; p < 0.001), prematurity (OR = 1.64; p = 0.025), poor family support (OR = 1.52; p = 0.016), dissatisfaction in marital life (OR = 1.26; p = 0.005), poor marital relationship (OR = 1.13; p = 0.05) were the main predictors of postpartum depression. CONCLUSION: This prevalence of postpartum depression in women living in Qatar was comparable to previous epidemiological research done in developing countries. Financial difficulties, prematurity, lack of family support, and poor marital relationships have been identified as main risk factors for developing postpartum depression.

Gender differences in prevalence of somatoform disorders in patients visiting primary care centers.

The aim of this study was to examine the gender differences in the prevalence of somatoform disorders among a sample of Qatari patients who were visiting primary health care centers and to investigate the severity of diagnostic categories and the most frequent somatic symptoms in these patients. The first stage of the study was conducted with the help of general practitioners, using the somatic symptom module of the Patient Health Questionnaire 12-item General Health Questionnaire. Overall, 2320 subjects were approached, and a total of 1689 patients, of whom 892 were men and 797 were women, agreed to participate in the study. The prevalence rate of somatoform disorders among the total screened sample was 23.9%. The prevalence rate was slightly higher in Qatari women (24.2%) than in Qatari men (23.7%). Housewives (43.5%) and men in administrative posts (37.9%) reported higher somatic symptoms compared to other professions. Prolonged depressive reaction was significantly higher in women compared to men (P = .003). There was a significant gender difference in certain psychiatric diagnostic categories such as depressive episode, recurrent depressive disorder, dysthymia, and brief depressive reaction. Backache was the most common reported symptom in men, whereas headache was more common in women. The present study revealed that the prevalence of somatoform disorders in Qatar is as high as the overall prevalence reported in prior studies done in other primary care settings. The prevalence of somatoform disorders was slightly higher in Qatari women than in men.

Epidemiological survey of knowledge, attitudes, and health literacy concerning mental illness in a national community sample: a global burden.

UNLABELLED: The aim of this study was to examine the knowledge, attitudes, and practices concerning mental illness among Qatari and other Arab expatriates. METHOD: This is a cross-sectional survey conducted from October 2008 to March 2009. A questionnaire was designed to assess knowledge, attitude, and practice regarding mental illness. RESULTS: Of 2254 subjects surveyed, 49.6% were Qataris, 50.4% other Arab expatriates, 54.8% males, and 45.2% females. A majority of the respondents thought that substance abuse like alcohol or drugs could result in mental illness (84.7%). Fewer than half of the subjects believed that mentally ill people are mentally retarded (40.6%). 48.3% believed that mental illness could result from punishment from God. The most common information source on mental illness was media (64.2%). Recognition of common mental disorders in the studied population was poor (72.5%). CONCLUSION: Knowledge of mental illness among the Arabic-speaking population of Qatar was quite poor.

Late-life depression: a neuropsychiatric approach.

Late-life depression refers to depressive syndromes defined in the American Psychiatric Association's Diagnostic and Statistical Manual and in the International Classification of Diseases that arise in adults older than 65 years of age. Late life depressive syndromes often arise in the context of medical and neurologic disorders. There is a high prevalence of depression in various neurodegenerative disorders such as Alzheimer's disease, Lewy body disease, Parkinson's disease, cerebrovascular disease and frontotemporal dementias. It has been well recognized that late life depression may itself be the presenting symptom of a latent neurodegenerative disorder. Therefore, an accurate diagnosis of late-onset depression may serve to identify a high-risk group that would benefit from initiation of therapies with the goal of delaying or possibly even preventing the onset of dementia.

Recent advances in Parkinson's disease therapy: use of monoamine oxidase inhibitors.

Monoamine oxidase inhibitors inhibit dopamine metabolism and are therefore effective in treating Parkinson's disease, a condition associated with progressive striatal dopamine deficiency secondary to degeneration of dopaminergic neurons in the substantia nigra. Selegiline is currently the most widely used monoamine oxidase-B inhibitor for Parkinson's disease, but has a low and variable bioavailability, and is metabolized to L-methamphetamine and L-amphetamine that carry a risk for potential neurotoxicity. There are two new approaches that circumvent these potential disadvantages. First, selegiline orally disintegrating tablets provide a novel delivery form of selegiline, avoiding first pass metabolism by rapid absorption through the oral mucosa, thus leading to significantly lower plasma concentrations of L-metamphetamine and L-amphetamine. Selegiline orally disintegrating tablets prove to be clinically effective and safe in patients with moderately advanced Parkinson's disease. Second, rasagiline is a new monoamine oxidase inhibitor, without known neurotoxic metabolites. In large clinical trials, rasagiline proves effective as monotherapy in early Parkinson's disease, as well as adjunctive therapy to levodopa in advanced disease. Clinical data suggest, in addition, a disease-modifying effect of rasagiline that may correlate with neuroprotective activity of monoamine oxidase-B inhibitors in animal models of Parkinson's disease.

The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists.

PURPOSE: The diagnosis of psychogenic pseudoseizures has improved with the availability of video-electroencephalography (EEG) monitoring; however, the outcome of this difficult disorder has remained poor. In an attempt to elucidate factors contributing to this poor outcome, we hypothesized that neurologists and psychiatrists differ in their views of the diagnosis and management of psychogenic pseudoseizure patients. METHODS: The hypothesis was tested by using a brief anonymous questionnaire administered to neurologists and psychiatrists at continuing medical education (CME) conferences. RESULTS: We found that neurologists and psychiatrists differ significantly in their opinion as to the accuracy of the video-EEG procedure; psychiatrists view video-EEG as often inaccurate in the diagnosis of psychogenic pseudoseizures compared with neurologists (p < 0.001). Neurologists, more frequently than psychiatrists, thought that patients' own psychopathology rather than "doctors dropping the ball" was a predominant factor in contributing to therapeutic failure, but this difference between specialties did not reach statistical significance. CONCLUSIONS: Resolving the differences between neurologists and psychiatrists would be helpful in caring for psychogenic pseudoseizure patients. These results support the need to encourage psychiatrists to have an integral involvement in epilepsy centers and to improve the understanding of psychogenic pseudoseizures in both disciplines.