Paliperidone Palmitate-Induced Delirium in an Adolescent with Schizophrenia: Case report

Schizophrenia is a serious long-term mental disorder which usually presents in adolescence or early adulthood. However, poor adherence to oral antipsychotics can lead to relapse and rehospitalisation. We report an adolescent male with schizophrenia who was referred to the South London & Maudsley National Health Service Foundation Trust, London, UK, in 2015 due to worsening psychotic symptoms. Following poor compliance with oral medications, a four-week regimen of paliperidone palmitate long-acting injections was initiated, with an initial positive response. However, 10 days after the second dose, the patient developed severe acute-onset delirium with fluctuating levels of consciousness. Paliperidone palmitate was discontinued and the patient instead underwent a course of zuclopenthixol decanoate long-acting injections with a favourable outcome. Keywords: Adolescent Psychiatry; Schizophrenia; Antipsychotic Agents; Delirium; Paliperidone Palmitate; Zuclopenthixol; Case Report; United Kingdom

Burnout Syndrome Among Primary Care Physicians in Oman

Objectives: Medical professionals are exposed to many job stressors everyday, which can lead to psychological disturbances as well as burnout syndrome. We sought to assess the level of burnout among primary care physicians (PCPs) in Oman and explore risk factors for its development. Methods: We conducted a cross-sectional, analytical study among a random cluster sample of 190 PCP working in Muscat, Oman. Indices of burnout (emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA)) were noted using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). We also used a questionnaire to obtain sociodemographic and job characteristics data. We used a binary logistic regression model and both unadjusted and adjusted odds ratios for statistical analysis. Results: The prevalence of burnout in all three dimensions was 6.3%. High levels of MBI-HSS subscales were reported on EE, DP and PA with 17.8%, 38.2%, and 21.5%, respectively. Logistic regression analysis revealed that working over 40 hours per week was the most important risk factor for burnout among PCPs. Conclusions: A total of 6.3% of PCPs working in urban areas in Oman suffered burnout. Long working hours was strongly associated with high occupational burnout. Solutions to eliminate or decrease the rate of burnout involve institutional changes, primarily respecting weekly working hours, and in more severe cases psychotherapy help is very important

The differential mediating roles of resilience in the relationship between meaningful living and stress among college students during the COVID-19 pandemic

The current literature, mostly Euro-American based, indicates that the presence of meaning in life (MIL) improves resilience and lowers stress. However, the differential mediating roles of resilience in the relationship between the search for and presence of MIL, and stress have not been explored. This study aimed to investigate the differential mediating roles of resilience in the relationship between the presence of and search for MIL, and stress among Omani college students amid the COVID-19 pandemic. This cross-sectional study consisted of the Brief Resilience Scale, Perceived Stress Scale 4, and Meaning in Life Questionnaire, as well as socio-demographic questions. A path analysis model was used to examine the hypothesis. A total of 970 Omani college students responded to the questionnaire. Findings indicate that searching for MIL was significantly associated with a high level of stress directly (β = 0.023; p < 0.001) and indirectly, through a negative effect on resilience (β =  0.006; p < 0.001). Conversely, the presence of MIL was significantly associated with a decreased level of stress directly (β = − 0.045; p < 0.001) and indirectly via a positive effect on resilience (β = − 0.151; p < 0.001). In keeping with the proposed hypothesis, this study contributes to the current knowledge, by extrapolating the effect of searching for MIL on resilience and stress, and culturally re-contextualizing MIL research. University counseling centers could adopt meaning-based strategies to mitigate stress by promoting meaningful living and resilience

Marine climate change risks to biodiversity and society in the ROPME Sea Area

The subtropical ROPME Sea Area (RSA), comprising the Gulf, the Gulf of Oman and the northern Arabian Sea, is a heavily exploited sea region that experiences extreme environmental conditions, and for which climate change is expected to further impact marine ecosystems and coastal communities, sectors and industries. Climate change risk assessments provide a valuable tool to inform decision-making and adaptation planning through identifying and prioritising climate risks and/or opportunities. Using the first UK Climate Change Risk Assessment as an example, a marine climate change risk assessment was undertaken for the marine and coastal environment of the RSA for the first time. Through an extensive literature review and a workshop involving regional experts, marine and coastal climate change risks were identified, scored and prioritised. A total of 45 risks were identified, which spanned two key themes: ‘Risks to Biodiversity’ and ‘Risks to Economy and Society’. Of these, 13 were categorised as ‘severe’, including degradation of coral reefs and their associated ecological assemblages, shifts in the distribution of wild-capture fisheries resources, changes to phytoplankton primary productivity, impacts on coastal communities, threats to infrastructure and industries, and impacts on operations and safety in maritime transport. The diversity of risks identified and their transboundary nature highlight that climate change adaptation responses will require coordinated action and cooperation at multiple scales across the RSA. This risk assessment provides a crucial baseline for a largely overlooked geographic area, that can be used to underpin future decision-making and adaptation planning on climate change, and serve as a ‘blueprint’ for similar assessments for other regional shared seas

Electroconvulsive therapy in Oman: a national audit of demographics and standards

Abstract Background We aim to address the dearth of knowledge regarding general electroconvulsive therapy practice in Oman, by examining and investigating the electroconvulsive therapy practices at all hospitals providing electroconvulsive therapy across the country, and to compare our local practice against the National Institute for Health and Care Excellence guidelines on the appropriate use of electroconvulsive therapy to inform the development of guidelines locally. Sultan Qaboos University Hospital and Al Masarra Hospital were included in a nationwide audit of all hospitals in Oman that administer electroconvulsive therapy. The demographics, diagnostic and electroconvulsive therapy indications, treatment characteristics, and side-effect profiles of all patients who had electroconvulsive therapy between January 2019 and December 2020 were collected from the hospital’s electronic data. A descriptive analysis of the results was performed. Results The total number of patients was 197 (92 males and 105 females). The most common diagnosis was schizophrenia 32.5%, followed by major depressive disorder 31.5%. The most common immediate side effect was headache 10.2%, followed by dizziness 7.1%, and amnesia 4.1%. Only 57.4% of patients who received electroconvulsive therapy met the NICE guidelines for appropriate electroconvulsive therapy use. Clinical status was assessed after each electroconvulsive therapy session for 66% of patients, and cognitive function monitoring was achieved for only 7.6% of patients. Conclusions The current audit has indicated that the assessment of the clinical status and cognitive functions of electroconvulsive therapy patients is inadequate. Because there is a significant rate of cognitive dysfunction following electroconvulsive therapy delivery, cognitive assessment before, during, and after therapy should be more rigorously implemented and documented

The Socio-Demographic and Clinical Profiles of Adult ADHD Patients in a University Hospital in Oman

Objectives: Although typically considered a condition affecting children, scientific evidence has shown that 30–50% of those diagnosed with ADHD in childhood continue to suffer from this condition after the age of 18. This study sought to address the gap in the literature, and to describe the socio-demographic and clinical characteristics of ADHD patients in a sample of adult patients attending an outpatient clinic at a tertiary care hospital in Oman, and to evaluate their association with the different subtypes of the disorder. Methods: Data from adult patients with ADHD from the outpatient clinic at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, were retrospectively collected from medical records from January 2018 to April 2020. Socio-demographic characteristics, clinical profiles and psychiatric co morbidities were examined. Results: This study included 100 adults who fulfilled the standard diagnosis of ADHD, with 54% (n=54), and 46% (n=46) from the inattentive and combined subtypes, respectively. It was found that ADHD was more prevalent among males (64.0%) compared to females (36%), with the inattentive subtype being more predominant among females. The ADHD patients with the inattentive subtype were associated with co-morbid substance use disorders (OR=11.29, P = 0.049), personality disorders (OR=7.96, P = 0.017), and major depressive disorder (OR=15.94, P = 0.002) compared to patients with the predominantly combined subtype. Conclusion: This study from Oman echoes the findings from the current literature, that adult patients with ADHD commonly have co-morbid psychiatric disorders, leading to significant functional impairment. Psychiatric co-morbidities must be identified and urgently treated, to allow for better clinical and functional outcomes in adult patients with ADHD. Keywords: ADHD, co-morbidity, hyperactivity, Oman, psychiatr

Prevalence and predictors of depressive symptoms among caregivers of children with attention-deficit/hyperactivity disorder attending a tertiary care facility: a cross-sectional analytical study from Muscat, Oman

A number of studies suggested that the rates of depression in Euro-American populations are higher among caregivers of children with attention-deficit/hyperactivity disorder (ADHD) than typically developing children. There is a dearth of studies in this field among non-Western populations. This study attempts to explore the depressive symptoms’ prevalence and predictors among a systematic random sample of caregivers of children with a diagnosis of ADHD who sought consultation from a child and adolescent mental health services unit in Muscat. The prevalence and predictors of depressive symptoms were quantified using the Patient Health Questionnaire-9. Results showed that depressive symptoms are common among caregivers of children with ADHD in Oman. A binary regression analysis revealed that low income, being the only caregiver in the family and hyperactive/impulsive and combined types of ADHD were significant predictors of depression

An Evaluation of the Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) for the Management of Treatment-Resistant Depression with Somatic Attributes: A Hospital-Based Study in Oman

Depressive illnesses in non-Western societies are often masked by somatic attributes that are sometimes impervious to pharmacological agents. This study explores the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for people experiencing treatment-resistant depression (TRD) accompanied by physical symptoms. Data were obtained from a prospective study conducted among patients with TRD and some somatic manifestations who underwent 20 sessions of rTMS intervention from January to June 2020. The Hamilton Rating Scale for Depression (HAMD) was used for clinical evaluation. Data were analysed using descriptive and inferential techniques (multiple logistic regression) in SPSS. Among the 49 participants (mean age: 42.5 ± 13.3), there was a significant reduction in posttreatment HAMD scores compared to baseline (t = 10.819, p < 0.0001, and 95% CI = 8.574–12.488), indicating a clinical response. Approximately 37% of the patients responded to treatment, with higher response rates among men and those who remained in urban areas, had a history of alcohol use, and were subjected to the standard 10 HZ protocol. After adjusting for all extraneous variables, the rTMS protocol emerged as the only significant predictor of response to the rTMS intervention. To our knowledge, this is the first study to examine the effectiveness of rTMS in the treatment of somatic depression

Ionization Radiation Shielding Effectiveness of Lead Acetate, Lead Nitrate, and Bismuth Nitrate-Doped Zinc Oxide Nanorods Thin Films: A Comparative Evaluation

The fabrication of Nano-based shielding materials is an advancing research area in material sciences and nanotechnology. Although bulky lead-based products remain the primary choice for radiation protection, environmental disadvantages and high toxicity limit their potentials, necessitating less costly, compatible, eco-friendly, and light-weight alternatives. The theme of the presented investigation is to compare the ionization radiation shielding potentialities of the lead acetate (LA), lead nitrate (LN), and bismuth nitrate (BN)-doped zinc oxide nanorods-based thin films (ZONRs-TFs) produced via the chemical bath deposition (CBD) technique. The impact of the selected materials&rsquo; doping content on morphological and structural properties of ZONRs-TF was investigated. The X-ray diffractometer (XRD) analyses of both undoped and doped TFs revealed the existence of hexagonal quartzite crystal structures. The composition analysis by energy dispersive (EDX) detected the corrected elemental compositions of the deposited films. Field emission scanning electronic microscope (FESEM) images of the TFs showed highly porous and irregular surface morphologies of the randomly aligned NRs with cracks and voids. The undoped and 2 wt.% BN-doped TFs showed the smallest and largest grain size of 10.44 nm and 38.98 nm, respectively. The linear attenuation coefficient (&micro;) values of all the optimally doped ZONRs-TFs measured against the X-ray photon irradiation disclosed their excrement shielding potency. The measured &micro; values of the ZONRs-TFs displayed the trend of 1 wt.% LA-doped TF &gt; 1 wt.% LN-doped TF &gt; 3 wt.% BN-doped TF &gt; undoped TFs). The values of &mu; of the ZONRs-TFs can be customized by adjusting the doping contents, which in turn controls the thickness and morphology of the TFs. In short, the proposed new types of the LA-, LN- and BN-doped ZONRs-TFs may contribute towards the development of the prospective ionization radiation shielding materials

Supplemental Material - Correlates of poor clinical outcomes related to COVID-19 among older people with psychiatric illness - a mixed methods study

Supplemental Material for Correlates of poor clinical outcomes related to COVID-19 among older people with psychiatric illness - a mixed methods study by Surajudeen Abdulrahman, Naser Al-Balushi, Jason Holdcroft-Long, Uzma Khan, Bipin Ravindran, Sujata Das, and Anto P Rajkumar in The International Journal of Psychiatry in Medicine</p