Dual mapping of MTHFR C677T (A1298C) and BDNF G196A (Val66Met) polymorphisms in patients with diabetic peripheral neuropathy

OBJECTIVE

Diabetic peripheral neuropathy (DPN) is a loss of distal sensory function in the lower limbs that is accompanied by pain and severe morbidity. The goal of this study was to perform a screening of the MTHFR C677T (A1298C) and BDNF G196A (Val66Met) polymorphisms and determine their possible relationships using biochemical blood tests and clinical presentations of symptoms in Jordanian patients with DPN.

PATIENTS AND METHODS

A cross-sectional study was conducted, and medical records were used to identify and recruit patients with DPN and collect their demographic and clinical characteristics. The total neuropathy score (TNSr) was used to assess the severity of sensory symptoms. In addition, direct sequencing was performed after Polymerase Chain Reaction (PCR) amplification to screen the two single nucleotide polymorphisms (SNPs) of interest.

RESULTS

Ninety patients with DPN participated in the study. The MTHFR-SNP variant (CT) and (TT) genotypes were identified in 39 (43.3%) and 19 (21.1%) patients, respectively. On the other hand, the BDNF-SNP variant (GA) and (AA) genotypes were identified in 22 (24.4%) and 11 (12.2%) patients, respectively. The distributions of the genotype frequencies of the MTHFR-SNP and BDNF-SNP variants statistically differed between patients with DPN and the control group (p < 0.0001, p < 0.002). Moreover, patients carrying variant genotypes of the two analyzed SNPs were more likely to have unsatisfactory HbA1c levels (> 7 mg/dl, p = 0.029) and moderate to severe symptoms (TNSr score 8-24).

CONCLUSIONS

The results of this study show that the MTHFR C>T-677 SNP and the BDNF G>A-196 SNP can be used as genetic risk markers for DPN. Assessing patients' genetic-metabolic risk profiles is recommended for providing personalized treatment.

The Arabic Questionnaire for Psychotic Experiences in patients with psychotic disorders: a clinical validation

BACKGROUND

Psychotic experiences are reported in the general population. The Questionnaire for Psychotic Experiences (QPE) was created to test the phenomenological features of these experiences and compare them with those reported in patients with psychiatric and other medical conditions. The aim of this study was to test the psychometric properties of the Arabic version of the QPE.

METHODS

We recruited 50 patients with psychotic disorders from the Hamad Medical Hospital in Doha, Qatar. Patients underwent assessment over three sessions with trained interviewees using the Arabic versions of QPE, Positive and Negative Syndrome Scale (PANSS), Beck Depression Inventory (BDI), and the Global Assessment of Functioning Scale (GAF). Patients were also reassessed using the QPE and GAF after 14-days from the initial assessment in order to test for the stability of the scale. In this respect, this is the first study that assesses the test-retest reliability of the QPE. The psychometric properties including convergent validity, stability, and internal consistency met the benchmarked criteria.

RESULTS

Results confirmed that the Arabic version of QPE accurately measured the experiences of patients that were also reported using the PANSS, an internationally accepted, well-established scale for measuring psychotic symptom severity.

CONCLUSION

We propose the use of the QPE to describe the phenomenology of PEs across modalities in Arabic speaking communities.

Cross-cultural Differences in Hallucinations: A Comparison Between Middle Eastern and European Community-Based Samples

BACKGROUND AND HYPOTHESIS

While literature indicates that culture modulates phenomenological characteristics of hallucinations in schizophrenia-spectrum disorders, little is known about the extent culture modulates these characteristics in nonclinical samples.

STUDY DESIGN

We compared lifetime prevalence, age of onset, and phenomenology of hallucinations as assessed with the Questionnaire for Psychotic Experiences between samples of nonclinical participants used from the Netherlands (N = 2999) and Qatar (N = 2999). While participant recruitment differed between the 2 countries, the samples were relatively equal in terms of demographic factors.

STUDY RESULTS

Our findings indicate that the lifetime prevalence of tactile and olfactory hallucinations are the same across countries. However, the prevalence of auditory hallucinations (AH) and visual hallucinations (VH) were twice as high in the Dutch sample. The reported age of onset for auditory and tactile hallucinations was younger for the Dutch sample. Findings from the measurement invariance supported cross-cultural comparisons with exception for duration, distress, and insight. Qatar's and Dutch participants reported similar valence and extent of interaction with AH and VH. However, compared to those in the Netherlands, participants from Qatar reported significantly more impact on daily functioning and a higher prevalence of receiving commands from hallucinations in the past week.

CONCLUSIONS

While AH and VH were more often reported in the Dutch sample, participants in Qatar generally had higher mean factor scores for past week AH and VH than in the Netherlands. The phenomenology of hallucinations in the Qatar sample was of greater clinical relevance, with potentially important implications for early screening and prevention.

Psychotic-like experiences among university female students in Qatar: A qualitative-phenomenological study

BACKGROUND AND AIMS

Psychotic-like experiences (PLEs) are hallucinatory or delusional experiences that fall below the threshold of a diagnosable psychotic disorder. Although PLEs are common across the spectrum of psychiatric disorders, they also have been commonly reported in the general population. In this study, we aimed to describe the types of PLEs experienced by university students in Qatar. Furthermore, we aimed to examine how students frame, explain, and deal with these experiences as well as understand how culture and religion may shape the way students attribute and respond to these experiences.

METHOD

This study used a qualitative phenomenological approach. For collecting the data, we conducted semi-structured interviews using the Questionnaire for Psychotic Experiences (QPE). The QPE is a valid and reliable tool to assess the phenomenology of psychotic-like experiences. The questionnaire was translated into Arabic and tested and validated in Qatar (a fast-developing Muslim country in the Arabian Peninsula). We conducted interviews in Arabic with 12 undergraduate female students at Qatar University (the only national university in Qatar). The interviewees were of different Arab nationalities. Interviews were transcribed verbatim and two authors conducted the content-thematic analysis separately, as a strategy to validate the findings. The study was part of a larger nationally funded project that was approved by the Qatar University Institutional Review Board. The approvals were granted before any interview was conducted.

RESULTS

The PLEs were prevalent in our non-clinical sample. The content-thematic analysis revealed the following main themes about these experiences: type, impact on daily function, frequency, immediate reaction, attribution style, assumptions about the root cause of these experiences, other associations, and religious links to experiences. The results also highlighted that religion and culture play a role in shaping the types of hallucinations and some delusions.

CONCLUSION

Our findings support the importance of culture and religion in relation to the types and explanations that students provided when describing PLEs. Notably, it was common among those who reported having these experiences to normalize and link PLEs to real-life events. This may be a defense mechanism to protect the self against the stigma of mental illness and from being labeled as "abnormal".

Pharmacogenetic screening of A1555G and C1494T mitochondrial mutations and the use of ototoxic drugs among Jordanians

OBJECTIVE

Hearing loss may impact an individual's psychosocial behaviors and lead to cognitive decline. The goals of this study were to describe the frequency of nonsyndromic hearing loss (NSHL) among Jordanian patients with regular exposure to ototoxic drugs, perform screening for A1555G and C1494T mitochondrial mutations (12S rRNA gene) and identify predictors of hearing loss.

MATERIALS AND METHODS

A cross-sectional study was conducted in which medical records were reviewed to record the pattern of ototoxic drug use among participants. The pure tone audiometry (PTA) test was used to assess hearing performance. Direct sequencing was performed following PCR amplification to screen for mitochondrial mutations of interest.

RESULTS

One hundred sixty-two patients reported regular use of ototoxic drug(s); sixty-five percent of them suffered from NSHL, mostly of mild-moderate severity. No A1555G or C1494T mutation was detected in any participant. Aspirin (82%) was the most commonly used ototoxic drug, followed by loop diuretics (77%) and aminoglycosides (57%). Advanced age, more comorbidities and more ototoxic drugs taken increased the likelihood of hearing loss (p<0.01).

CONCLUSIONS

Hearing loss is prevalent among Jordanian patients treated with ototoxic drugs. Early intervention and management services for this population remain critical needs.

Pharmacogenetic screening of A1555G and C1494T mitochondrial mutations and the use of ototoxic drugs among Jordanians

OBJECTIVE

Hearing loss may impact an individual's psychosocial behaviors and lead to cognitive decline. The goals of this study were to describe the frequency of nonsyndromic hearing loss (NSHL) among Jordanian patients with regular exposure to ototoxic drugs, perform screening for A1555G and C1494T mitochondrial mutations (12S rRNA gene) and identify predictors of hearing loss.

MATERIALS AND METHODS

A cross-sectional study was conducted in which medical records were reviewed to record the pattern of ototoxic drug use among participants. The pure tone audiometry (PTA) test was used to assess hearing performance. Direct sequencing was performed following PCR amplification to screen for mitochondrial mutations of interest.

RESULTS

One hundred sixty-two patients reported regular use of ototoxic drug(s); sixty-five percent of them suffered from NSHL, mostly of mild-moderate severity. No A1555G or C1494T mutation was detected in any participant. Aspirin (82%) was the most commonly used ototoxic drug, followed by loop diuretics (77%) and aminoglycosides (57%). Advanced age, more comorbidities and more ototoxic drugs taken increased the likelihood of hearing loss (p<0.01).

CONCLUSIONS

Hearing loss is prevalent among Jordanian patients treated with ototoxic drugs. Early intervention and management services for this population remain critical needs.

Self-Reported Sleep and Exercise Patterns in Patients with Schizophrenia: a Cross-Sectional Comparative Study

BACKGROUND

Adequate sleep and physical activity have been linked to the overall well-being of both medical and psychiatric patients. Patients with schizophrenia have shown abnormal sleep patterns and decreased physical activity that were linked to their psychopathology and physical health. These phenomena are not studied yet in Arab patients with schizophrenia. The purpose of this study is to study the sleep and exercise patterns in Arab patients with schizophrenia compared with those of healthy controls.

METHOD

A total of 99 patients with schizophrenia and 101 controls were recruited. Arabic versions of sleep, exercise, socio-demographic, and clinical questionnaires were administered as well as the validated scales to measure psychopathology, depression, and suicidality in these participants.

RESULTS

The majority of patients with schizophrenia slept more than 8 h per day and exercised less when compared with controls. Sleep quality was worse in those with higher depression score and higher suicidality scores were seen in patients with lower sleep duration. Multinomial regression showed that patients with schizophrenia have higher odds of sleeping more than 8 h even after controlling for the intake of antipsychotics, age, gender, smoking status, and other confounding factors.

CONCLUSION

Our results showed that Arab patients with schizophrenia are at increased risk of having longer sleep duration with inadequate physical activity, which are correlating with worsening of depressive symptoms and suicidality. Thus, more attention should be paid to the changes in sleep patterns and level of exercise when treating Arab patients with schizophrenia.

Risk Factors of Metabolic Syndrome Among Patients Receiving Antipsychotics: A Retrospective Study

This study aimed to assess the differential effects of first-generation (FGA) and second-generation antipsychotics (SGA) on the prevalence of risk factors for metabolic syndrome among mentally ill patients in Qatar. We also wanted to check if there is proper adherence with the guidelines for prescribing antipsychotics and the monitoring of metabolic effects in this population. We collected the available retrospective data (socio-demographic, psychiatric, anthropometric, and metabolic measures) from the records of 439 patients maintained on antipsychotics. The majority were males, married, employed, having a psychotic disorder, and receiving SGA. Patients on SGA showed more obesity, higher BP, and more elevated triglycerides compared to those on FGA. The prevalence of the abnormal metabolic measures was high in this sample, but those on SGA showed a significantly higher prevalence of abnormal body mass index and BP. Obesity and hypertension were common in patients maintained on antipsychotics, especially those on SGA. Polypharmacy was common, and many metabolic measures were not monitored properly in those maintained on antipsychotics. More prospective studies with guided monitoring of the patients' clinical status and metabolic changes are needed to serve better this population of patients.

Cross-cultural adaptation of the Arabic Positive and Negative Syndrome Scale in schizophrenia: Qualitative analysis of a focus group

As part of a project to translate and validate scales used in the diagnosis and treatment of Arab patients with schizophrenia, this study aimed to explore the experience of clinical research coordinators (CRCs) while administering the Arabic version of the Positive and Negative Syndrome Scale (PANSS) on Arab schizophrenia patients. We previously reported that the Arabic version of PANSS is a valid and reliable tool to assess Arab patients with schizophrenia. Five CRCs and the principal investigator attended focus group discussions on cultural issues in administering the PANSS. A thematic analysis approach was utilized for data coding and analysis. The results identified issues related to the translation of the instrument, the structure of the interview, the cultural sensitivity of some questions, and the procedures for rating items of the PANSS. Qualitative analysis also identified four main themes relevant to clinical assessment of patients from Middle Eastern cultures: religion, beliefs and values, gender, and semantic expressions. In conclusion, researchers or clinicians administering the PANSS scale interview in Arabic should be trained to consider the roles of local dialects, familiarity with abstract thinking, religion, and social constructs when assessing psychosis.

Relationships between sleep patterns and metabolic profile in patients maintained on antipsychotics: a cross-sectional comparative study

BACKGROUND

Disturbances in sleep duration and quality have been associated with obesity and other metabolic changes. Patients with mental disorders (MD) are known to have more sleep problems, and antipsychotics (AP), used in the treatment of these patients, can also cause weight gain. This study aimed to compare the self-reported sleep patterns between psychiatric patients (on or off AP) and controls. We also evaluated the associations between the clinical and metabolic profiles with short or long sleep duration.

METHODS

A total of 339 subjects was recruited: Mentally ill patients maintained on AP for at least six months (MD+AP, n=112), patients not taking AP for at least the last six months before enrollment (MD/noAP, n=101), and non-psychiatry controls (HC, n=126). Multinomial regression analysis was applied to find the predictors of irregular sleep duration in this sample.

RESULTS

More mentally ill patients (MD+AP and MD/noAP) reported a sleep duration of >8 hrs than HC. Patients from MD/noAP showed more insomnia than HC. Sleep disturbances were significantly more frequent in MD+AP than HC. Participants who reported sleeping >8 hrs had higher body mass index and waist circumference than those who slept <7 hrs.

CONCLUSION

Female gender, central obesity and being mentally ill were independently associated with long sleep duration (>8h) in the population of Qatar.

Job satisfaction and stress among healthcare workers in public hospitals in Qatar

This article explores predictors of job satisfaction and stress among clinicians and administrative staff at the public health sector in the State of Qatar. This is a rapidly growing sector, aiming for excellence in service, education and research. The vast majority of the staff are expatriates with different cultural backgrounds, and varying qualifications. After obtaining ethical approvals to conduct the study, the target population were asked to complete an anonymous online survey, that included sociodemographic data followed by the National Institute for Occupational Safety and Health (NIOSH) generic Job Stress questionnaire. Total number included in the analysis is 1260, female, married with children. Role ambiguity, conflict, skill underutilization and workload were associated with job dissatisfaction. Role and job future ambiguity were significantly associated with depression.

The prevalence of metabolic syndrome in patients receiving antipsychotics in Qatar: a cross sectional comparative study

BACKGROUND

Metabolic abnormalities are common in patients maintained on antipsychotics. These abnormalities increase the risk of cardiovascular diseases and mortality in this population. The aim of this study is to assess the prevalence of metabolic syndrome (MetS) in subjects maintained on antipsychotics relative to controls in Qatar, and to assess the factors contributing to the development of MetS.

METHODS

A cross sectional design was used to collect data and fasting blood samples from subjects maintained on antipsychotics for at least six months (n = 112) and from a control group (n = 114). The groups were compared in regard to prevalence of MetS, and multiple regression analysis was used to determine the risk factors in each group.

RESULTS

The two groups (antipsychotics vs. control) were similar in regard to age (35.73 ± 10.28 vs. 35.73 ± 8.16 years) and gender ratio. The MetS was higher among the subjects on antipsychotics, but this difference did not reach statistical significance. Blood pressure (BP) was significantly higher in the antipsychotics group and BMI was the major risk factor to develop MetS in this group.

CONCLUSIONS

The prevalence of MetS in both groups is high and mostly attributed to obesity and high BP. Public health interventions are needed to address this major health problem overall. Larger studies are needed to further assess the impact of antipsychotics and mental illness on the development of MetS.

Validation and cultural adaptation of the Arabic versions of the Mini-Mental Status Examination - 2 and Mini-Cog test

INTRODUCTION

The elderly population is increasing around the world, and the prevalence of dementia increases with age. Hence, it is expected that the number of people with dementia will increase significantly in the coming years. The Mini-Mental Status Examination - 2 (MMSE-2) and Mini-Cog are widely used tests to screen for dementia. These scales have good reliability and validity and are easy to administer in clinical and research settings.

AIM

The purpose of this study was to validate the Arabic versions of MMSE-2 and Mini-Cog. These scales were assessed against the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for dementia, as the gold standard.

METHODS

The standard versions of the MMSE-2 and Mini-Cog were translated to Arabic following the back-translation method. Then, a trained rater administered these tests to 134 Arab elderly aged >60 years. A physician, blind to the results of these two tests, assessed the participants for vascular dementia or probable Alzheimer's disease, based on the DSM-IV-TR criteria.

RESULTS

The sample included 67.2% Qataris. The mean age was 74.86 years (standard deviation =7.71), and 61.9% did not attend school. The mean of the adjusted scores of MMSE-2 based on age and education level was 19.60 (standard deviation =6.58). According to DSM-IV-TR, 17.2% of the participants had dementia. Sensitivity and specificity of the MMSE-2 and the Mini-Cog together were 71.4% and 61.6%, respectively, which were better than those of each test alone.

CONCLUSION

Together, the Arabic versions of MMSE-2 and Mini-Cog are good screening tools for cognitive impairment in Arabs.

Validation of the Five-Factor Model of the Arabic Version of the Positive and Negative Syndrome Scale in Schizophrenia

BACKGROUND

The Positive and Negative Syndrome Scale (PANSS) is a widely used assessment for patients with schizophrenia across clinical and research settings. This scale allows the classification of the psychotic symptoms to better understand the psychopathology in patients with schizophrenia. There are no available data on the different components of psychopathology in Arab patients with schizophrenia.

OBJECTIVES

This study examined the factor structure of the validated Arabic version of the PANSS in a sample of Arab patients with schizophrenia.

METHODS

The Arabic version of the PANSS was administered to 101 patients with schizophrenia, and principal component analysis (PCA) was carried out after the cross-cultural adaptation and validation of this version.

RESULTS

This sample had more males (66.3%) than females (33.7%) with a mean age of 35.03 years (SD = 9.99). PCA showed that 28 items loaded on 5 components: cognitive, negative, excited, depressed and positive. These factors explained 63.19% of variance. The 2 remaining items, grandiosity and somatic concerns, did not load well on any of these components.

CONCLUSION

Our results support the common 5-dimension PANSS model shown in other cultures with different languages. Nevertheless, there were minor differences, which could reflect cultural or semantic differences.

Reliability, validity and factorial structure of the Arabic version of the international suicide prevention trial (InterSePT) scale for suicidal thinking in schizophrenia patients in Doha, Qatar

BACKGROUND

Patients with schizophrenia are known to have higher rates of mortality and morbidity when compared to the general population. Suicidality is a major contributor to increased mortality. The International Suicide Prevention Trial (InterSePT) Scale for Suicidal Thinking (ISST) is a validated tool to assess current suicidal ideation in patients with schizophrenia. The aims of the study were to culturally adapt the Arabic translation of ISST and to examine the psychometric characteristics of the Arabic version of the ISST among patients with schizophrenia in Qatar.

METHODS

ISST was translated and adapted into formal Arabic using the back translation method. Patients diagnosed with schizophrenia were randomly recruited from the department of Psychiatry, Rumailah Hospital, Doha, Qatar. Healthy controls were randomly recruited from two primary health care centers in Doha, Qatar. The Arabic version of Module B for suicidality in Mini International Neuropsychiatric Interview was used as the gold standard to which the Arabic ISST was compared.

RESULTS

The study sample (n = 199) was composed of 100 patients diagnosed with schizophrenia (age 35.30 ± 10.04 years; M/F is 2/1) and 99 controls (age 33.98 ± 8.33 years; M/F is 2/3). The mean score on the ISST was 3.03 ± 4.75 vs. 0.47 ± 1.44 for the schizophrenia and control groups, respectively. Inter-rater reliability coefficient was 0.95, p > 0.001. The overall Cronbach's alpha was 0.92. Principal Component Analysis produced 3 factors explaining a total of 73.8% of variance.

CONCLUSIONS

This is the first study in the Arab countries to validate the Arabic version of the ISST. The psychometric properties indicate that the Arabic ISST is a valid tool to assess the severity of suicidal ideation in Arabic patients with schizophrenia.

Validation of the Arabic Version of Calgary Depression Scale for Schizophrenia

BACKGROUND

Patients with schizophrenia commonly show both depressive and negative symptoms that can differentially affect the prognosis and course of treatment. The Calgary Depression Scale for Schizophrenia (CDSS) was designed to distinguish between depression and negative symptoms in patients with schizophrenia. The purpose of this study is to validate an Arabic version of the CDSS among patients with schizophrenia.

METHODS

The diagnosis of schizophrenia was confirmed using the Arabic Mini International Neuropsychiatric Interview 6 (MINI 6). A standardized translation back-translation process was adopted. One rater administered the Arabic CDSS to subjects with schizophrenia as well as to a control group who should not have any psychiatric disorder except for depression. Another rater, blinded to the results administered the already validated Arabic version of Beck Depression Inventory-II (BDI-II).

RESULTS

We recruited 102 patients and 102 controls subjects. The CDSS showed good internal consistency in the active group (Cronbach's alpha = 0.82). The Intraclass Coefficient correlations (ICC) for the inter-rater reliability (n = 21) was 0.90, p<0.05 and test-retest reliability (n = 19) was 0.85, p<0.001. When compared to the BDI-II, the cutoff score of 5 on the Arabic CDSS showed reasonable sensitivity and specificity of 72.75% and 67.95% respectively.

CONCLUSIONS

The psychometric properties of the Arabic version of CDSS demonstrate that it is a valid tool to assess the depressive symptoms in the Arab patients with schizophrenia.

Validity and Reliability of the Arabic Version of the Positive and Negative Syndrome Scale

BACKGROUND

The Positive and Negative Syndrome Scale (PANSS) is widely used for patients with schizophrenia. This scale is reliable and valid. The PANSS was translated and validated in several languages.

OBJECTIVE

The aim of this study was to translate and validate the PANSS in the Arab population.

SUBJECTS AND METHODS

The PANSS was translated into formal Arabic language using the back-translation method. 101 Arab patients with schizophrenia and 98 Arabs with no diagnosis of any mental disorder were recruited. The Arabic version of the Mini International Neuropsychiatric Interview (MINI-6) was used as a diagnostic tool to confirm the diagnosis of schizophrenia or rule out any diagnosis for the healthy control group. Reliability of the scale was assessed by calculating internal consistency, interrater reliability and test-retest reliability. Construct validity was assessed using the Arabic version of the MINI-6. PANSS total scores were correlated with the Clinical Global Impression-Severity scale.

RESULTS

Our findings showed that the internal consistency was good (0.92). Scores on the PANSS of the patients were much higher than those of the healthy controls. The PANSS showed good interrater reliability and test-retest reliability (0.92 and 0.75, respectively). In comparison with the MINI-6, the PANSS showed good sensitivity and specificity, which implies good construct validity of this version.

CONCLUSION

In conclusion, the Arabic version of the PANSS is a reliable and valid instrument for the assessment of patients with schizophrenia in the Arab population.