Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools

Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors. Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences. Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m2 (p = 0.815). Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.qscienc

Healthcare practitioners’ views of their role in addressing the medical comorbidites of people with mental illness

Objectives: To explore the views and experiences of different healthcare professionals in Qatar about their role addressing the medical comorbidities of people with serious mental illness (SMI). Subjects and Methods: Qualitative study using a purposive sampling strategy to include representative viewpoints from physicians, pharmacists, and nurses working at outpatient settings throughout Doha, Qatar. Semi-structured interviews were conducted, and transcripts analyzed employing qualitative phenomenological approach to inquiry. Results: A total of eighteen interviews to healthcare practitioners (HCPs) were conducted. Four major common themes emerged from these interviews, including: 1) knowledge and awareness about the medical comorbidities among people with serious mental illness (SMI); 2) perceptions of current practice in relation to addressing the medical comorbidities of people with SMI; 3) perceived barriers to the provision of medical care to people with SMI; 4) possible solutions to address the barriers identified. Conclusion: Results of this study suggest that HCPs perceive that people with SMI in Qatar receive suboptimal standard levels of care for their medical comorbidities. The integration of medical and mental healthcare services and fostering shared responsibility that includes family members were strongly recommended to improve the physical health of people with SMI

Assessing Pharmacists Knowledge and Attitude Toward the Direct Oral Anticoagulants in Qatar

Pharmacists were found to play a key role in anticoagulation care. In order to make an appropriate selection and counselling regarding direct oral anticoagulants (DOACs), pharmacists should be knowledgeable and abiding by evidence-based practice. We aim in this study to assess the knowledge and practices of practicing hospital and community pharmacists in Qatar regarding DOACs and their reflection on the dispensing and patient education. A prospective cross-sectional survey was developed. It included questions on demographic and professional characteristics. Additionally, it evaluated the awareness regarding safety, efficacy, and dispensing of DOACs. Lastly, a separate question was used to address the participant’s satisfaction with their knowledge. A total response were received from 211 pharmacists participating in the survey. Overall awareness score was moderate (41.6% ± 26%). These scores were in alignment with participants’ self-satisfaction with knowledge on DOACs (72% of participants were not satisfied). Being a clinical pharmacist, of male gender, and with a board certification were factors associated with increased awareness on DOACs. Results from this survey point to the importance of having more educational activities in order to improve pharmacist’s knowledge of DOACs.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The publication of this article was funded by the Qatar National Library.Scopu

A brief history and challenges of clozapine utilization in the Arab world

Clozapine synthesis dates back to 1958, when a Swiss pharmaceutical company produced it based on the chemical structure of the tricyclic antidepressant imipramine (Crilly, 2007; Idänpään-Heikkilä et al., 1975). Clinical trials in humans started in the 60's, but it was not until the early 70s when clozapine was first introduced into the European market as Leponex® by Sandoz pharmaceutical company (Crilly, 2007). Initial trials of clozapine in the United States (US) took place in 1975, at around the same time that 16 cases of agranulocytosis leading to 8 deaths in clozapine-treated patients, reported from 6 hospitals mostly in southwestern Finland, raised concerns on its safety and led to its withdrawal from the US market, although it remained available in some European countries (Idänpään-Heikkilä et al., 1975). Clozapine was then reintroduced in the US in the early 1990s for the management of treatment resistant schizophrenia (TRS) under a strict mandatory hematological monitoring system which was mostly supported by the manufacturer of clozapine (Bachmann et al., 2017; Nielsen et al., 2016)

Opinions and experiences on the provision of care to people with mental illnesses: a qualitative study with Doctor of Pharmacy graduates after a rotation in psychiatry.

Pharmacists are vital to optimizing therapy of people with mental illnesses. Limited knowledge, lack of confidence, and mental health-related stigma can lead to pharmacists' reluctance in the provision of pharmaceutical care to this population. Advanced pharmacy practice experiences (APPE) in mental health have been reported as valuable learning opportunities to overcome these challenges. This study aimed to explore PharmD graduates' perceived preparedness, attitudes, beliefs, and opinions on influencing factors for the provision of pharmaceutical care to people with mental illnesses after completing an APPE rotation in psychiatry. All PharmD graduates who had completed a rotation in psychiatry were invited to participate in semi-structured interviews. An interview guide was developed based on a literature review. A total of 11 PharmD graduates agreed to participate in the interviews, which were recorded, transcribed, and analysed inductively using thematic analysis and following a phenomenological approach. Five themes were identified: Prior familiarity to mental health, opinions on the rotation, views on stigma, rotation's areas of improvement, and the positive impact of the rotation on practice. Although participants started the psychiatric rotation with low confidence and a sense of apprehension, they described their experience as unique, eye-opening, and insightful. Familiarity with mental health conditions before the rotation were perceived as a challenge to achieving full confidence in mental health care provision. For the most part, the APPE in psychiatry was viewed as a positive opportunity for enhancing the PharmD graduates' insight, knowledge, and skills for pharmaceutical care provision to people with mental illnesses

An Exploration of Smoking Patterns Among People with Serious Mental Illness Attending an Outpatient Clinic in Qatar

Background: Studies have shown that tobacco use is exceptionally high in people affected with serious mental illness (SMI). Many countries worldwide have observed a decrease in the prevalence of tobacco smoking; however, the smoking rates among people with SMI have declined much less than in those without mental illness. To date, no nationally representative data have examined the smoking patterns or the sociocultural factors that influence smoking among SMI people in Qatar. Methods: A retrospective medical chart review was conducted to collect patient demographics, psychiatric and medical comorbid-ities, medications, the most recently documented smoking status and if on tobacco cessation treatment. A descriptive and inferential analysis of the data was performed. Results: Of 346 patients included in the cohort, 196 (56.6%) had their smoking status documented, of which 72 (36.7%) were “currently smoking.” Significantly more males than females were “current smokers” (62.9% versus 15.0%, respectively, p < 0.001). Significantly more patients with psychotic disorders than those with any other SMI were “current smokers”, and this difference was statistically significant (p = 0.006). Positive and significant associations with current smoking were found for the male gender, psychotic disorders, and high levels (≥6.2 mmol/L) of total cholesterol. Only 12 (16.7%) of current smokers were receiving smoking cessation treatment. Conclusion: More than half of a sample of people with SMI attending outpatient psychiatric services in Qatar had documented smoking status. Still, only a few current smokers were on smoking cessation treatment. Efforts are needed to implement smoking cessation strategies in this population.Open Access funding provided by the Qatar National Library

A qualitative exploration of clozapine prescribing and monitoring practices in the Arabian Gulf countries

Clozapine is considered as the first line antipsychotic for treatment resistant schizophrenia (TRS). Worldwide reports indicate an overall underutilization of clozapine in patients experiencing TRS. This study aims to understand the prescribing practices, monitoring strategies and barriers to the use of clozapine in the Arabian Gulf (AG) region. Qualitative methodology was employed to explore mental health professionals’ experience with clozapine prescribing practices. Semi-structured, individual in-depth interviews were conducted. All interviews were analyzed using a thematic approach. A total of 13 interviews were conducted with participants from six AG countries. Four major themes emerged from the analysis in relation to clozapine prescribing and monitoring practices, clozapine use guidelines, and barriers to the use of clozapine. Thematic analysis revealed a tendency to under prescribe clozapine in the AG region, which appears to be predominantly influenced by prescriber-related barriers and less likely due to the lack of a nation-wide hematological monitoring program. Future studies should explore strategies for overcoming the barriers identified.This research was funded by a Qatar University Undergraduate Student grant (reference: QUST-2-CPH-2017-9). We would like to thank all participants in the six AG countries and those who assisted us with the recruitment process. We would like to extend particular thanks to Dr. Jonathan G. Leung, psychiatric clinical pharmacist at Mayo Clinic Hospital in the United States who helped us piloting the interview guide questions in addition to his guidance in regards to the US FDA REMS program for clozapine.Scopu

Medical comorbidities in patients with serious mental illness: A retrospective study of mental health patients attending an outpatient clinic in Qatar

Background: The life span of individuals with serious mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. The aim of the study was to investigate the prevalence rates of different physical illnesses in individuals with SMI and to examine how these are being managed. Methods: The study was a cross-sectional retrospective chart review of a cohort of patients with SMI. A comprehensive electronic data extraction tool using SurveyMonkey. was used to collect patient demographics, psychiatric and medical comorbidities, medications and all relevant physical assessments. Data were then first extrapolated into an Excel. spreadsheet and later to SPSS. for data analysis. A descriptive statistical approach was used to analyze the demographic and clinical data. Chi-square test for categorical variables and t-test for continuous variables were used to compare the demographic and clinical characteristics of the cohort. Results: A total of 336 patients with SMI were included for the retrospective chart review. The majority of these patients had a diagnosis of depression (50.3%), followed by schizophrenia (33.0%) and bipolar disorder (19.6%). Diabetes was the most frequent medical comorbidity, diagnosed in 16.1% of SMI patients, followed by hypertension (9.2%) and dyslipidemia (9.8%). Monitoring of comorbidity-associated risk factors and other relevant physical assessment parameters (such as blood pressure, weight, hemoglobin A1c [HbA1c], blood glucose and lipids) were documented in less than 50% of patients, and some parameters, such as smoking status, were not documented at all. Conclusion: Both, the literature and our cohort provide evidence that individuals with SMI are less likely to receive standard levels of care for their medical comorbidities.This study was made possible by a UREP grant (UREP18-060-3-016) for undergraduate research from the Qatar National Research Fund (a member of Qatar Foundation).Scopu

Long-acting injectable antipsychotics: A systematic review of their non-systemic adverse effect profile

Introduction: Long acting injectable (LAI) antipsychotics are commonly used in the treatment of schizophrenia to improve adherence and clinical outcomes. Concerns have been reported in relation to their non-systemic or injection site adverse effect profile. As such, this study aims to review and evaluate all evidence reporting injection site adverse effects with LAI antipsychotics. Methods: An electronic search was systematically conducted through four databases (PubMed, Embase, SCOPUS, Cochrane) in order to identify studies investigating injection-site reactions associated with LAI antipsychotics. Unpublished studies such as conference proceedings and clinical trial registries were also searched. The search was limited to literature published in English without year limits. Results: Of a total of 189 citations that were identified from the electronic database search, 12 were selected for inclusion in this review. Various injection site reactions were reported in these studies, including pain, bleeding, and swelling. Overall, the studies reported a low incidence of these injection site reactions. Only a minority of the included articles compared injection site reactions between different LAI antipsychotics. Conclusion: Injection site pain was the most commonly reported injection site adverse effect across all articles reviewed. The low incidence of injection site adverse effects associated with LAI antipsychotics indicates that these formulations appear to be well tolerated by patients. More head-to-head trials comparing second generation LAI antipsy-chotics are needed

Clozapine prescribing and safety during COVID-19

Schizophrenia is a chronic mental disorder affecting 20 million people worldwide (James et al., 2018). Clozapine remains the most effective pharmacological treatment for schizophrenia but requires regular blood monitoring due to its propensity to cause agranulocytosis. The Coronavirus disease 2019 (COVID-19) begot unprecedented restrictions on provision of psychiatric services and precautionary measures stood as major obstacles to healthcare access (Grover et al., 2020). An expert subgroup of the Treatment Response and Resistance in Psychosis Working Group (TRRPG) developed recommendations to face COVID-related challenges, including the dispensation of medication for up to 90 days and reducing the frequency of Absolute Neutrophil Count (ANC) testing to once every 3 months for patients who had been on clozapine for more than one year with no previous record of neutropenia (Siskind et al., 2020). We aimed to evaluate the trend of clozapine prescriptions during the COVID-19 pandemic in Qatar. Our secondary objectives were to evaluate the rate of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection among patients on clozapine; rates of neutropenia and related medical complications; clozapine toxicity; psychiatric and medical admissions during this period and whether these variables were associated with revised clozapine dispensation and blood monitoring.Scopu