Introduction The prevalence of any disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is 34.2% in Saudi Arabia over the course of a person's lifetime. Young Saudis are more likely to develop major depressive disorder than older Saudis. Globally, postgraduate students are more vulnerable to developing depression compared to the general population. According to a national study carried out in Saudi Arabia, a small proportion of individuals experiencing psychiatric disorders over a period of 12 months receive any kind of treatment. This highlights the importance of community education aimed at enhancing mental health awareness. Methods A web-based Arabic cross-sectional survey was conducted among Saudi postgraduate students from October 2019 to August 2020. The survey included questions related to sociodemographic characteristics, sources of information, depression literacy (D-Lit), the Patient Health Questionnaire-9 (PHQ-9) for depression, and the participants’ attitudes toward depression. Results A total of 517 participants took part in the survey, with 46% of them screened positive for depression. The mean D-Lit score was 10.65, which was lower than that reported in studies conducted among medical students and hospital staff. No significant differences were found in D-Lit scores across all sociodemographic characteristics, except for gender and specialty ( p = 0.002 and <0.001, respectively). The Internet, awareness posters, a doctor (previously diagnosed with depression), and awareness activities related to depression showed significant differences in the mean score of D-Lit ( p < 0.001, 0.005, < 0.001, and < 0.001, respectively). Conclusion In Saudi Arabia, this study found that postgraduate students have a notably higher occurrence of depression compared to the general population. However, despite their higher educational level, these students lacked sufficient awareness and understanding of depression to recognize it and seek help. Consequently, it is important to initiate awareness campaigns aimed at enhancing the mental well-being of postgraduate student

Background: Depression and anxiety are indicators of mental health and quality of life. Studies found a high prevalence of depression and anxiety disorders among specific populations, such as medical students, residents and fellows. However, postgraduate students unarguably suffer from many private and career life stressors. Unfortunately, research about the prevalence of depression and anxiety among postgraduate students are greatly lacking. Methods: A cross-sectional online survey; a self-questionnaire divided into five sections. Socio-demographic characteristics, the Patient Health Questionnaire for Depression (PHQ9), Generalized Anxiety Disorder 7 item (GAD7), insomnia and suicide. Results: The number of participants was 1,005, The prevalence of depression and GAD that warrant treatments are 27.4% and 23.6%, respectively. Most of the participants who screened positive for depression and GAD were not aware of having these disorders. Females were at a higher risk of depression (OR: 1.5, 95% CL: 1.10 to 2.15) and GAD (OR:1.49, 95% CL 1.07 to 2.07). Insomnia is associated significantly with depression (P<0.001) and GAD (P<0.001). Depression increases the risk for active suicide thoughts (OR= 7.453) (P<0.001). Conclusion: We have identified a higher prevalence of depression and GAD among postgraduate students compared with the general population. However, they appear to be underrepresented in mental health literature, so further research is necessary. The limitations of this study were centered on the nature of cross-sectional studies, causal relationships cannot be identified.

Background: The impact of the COVID-19 pandemic on populations' mental health has started to emerge. Objectives: To describe the mental health trends of the risk of major depressive disorder (MDD) and generalized anxiety disorder (GAD) between May and August 2020. It also compares the results with pre-COVID-19 results and identifies risk factors associated with increased likelihood of being at risk of MDD and GAD. Method: This study utilizes repeated cross-sectional design, at national-level coverage of mental health screenings via computer-assisted phone interviews conducted in four waves monthly (between May and August 2020). Arabic-speaking adults from Saudi Arabia were recruited via a random phone list. The questionnaire includes the Arabic version of the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Pre-COVID-19 comparison was done using the PHQ-2 score to allow for comparison with a previous and similar national study conducted in 2018. Results: Across the four waves, 16,513 participants completed the interviews, with an overall response rate of 81.3%. The weighted national prevalence of people at risk of MDD was 14.9% overall, and 13.8%, 13.6%, 16.8%, and 15.3% in Waves 1, 2, 3, and 4, respectively. The weighted national prevalence of people at risk of GAD was 11.4%, overall, and 10.9%, 10.7%, 12.4%, and 11.7% in Waves 1, 2, 3, and 4, respectively. The weighted national proportion of individuals who were at risk of MDD and GAD at the same time was 7.4% overall. The risk of MDD on PHQ-2 increased by 71.2%, from 12.5% in 2018 to 21.4% in 2020. Conclusions: The risks of MDD and GAD in this study are relatively high. These results can help decision makers to understand the impact of the COVID-19 pandemic on the population's mental health and the most-impacted subgroups.

Research problem Advances in technology have ensured its inevitable integration in our life. Children, being at a vulnerable age period of development, are spending more time on electronic devices. Some studies reported negative effects on sleep, physical health such as obesity and vision problems, and behavioral changes such as aggressive behavior with exposure to violent media content. Research significance We will study the effect of using electronic devices on communication skills in children in Saudi Arabia. Our findings can be used to raise awareness on this matter. Research objectives The aim of our study is to examine the association between screen time and social communication skills among children of four years to six years of age in Saudi Arabia. Research methodology A cross-sectional study was conducted to investigate the relationship between social skills development and screen time by using a validated Arabic version of the Social Communication Questionnaire (SCQ). The sample in this study consists of 308 children from four to six years of age. Research results The results showed that the hours spent using the electronic device were significantly associated with having an SCQ score ≥ 15 (P < 0.05). A high SCQ score was prevalent in 19.7% (n = 31) of children who spent >3 hours using an electronic device compared to 10.2% (n = 5) and 7.84% (n = 8) of children who spent an hour or <2 hours using electronic devices, respectively. Conclusion Our study highlighted a significant association between the daily hours spent on devices and having an SCQ score above 15, which suggests a deficit in social skill development and having autism spectrum disorder-like symptoms.

Background Smartphone addiction, as with other behavioral addictions, is associated with social, physical, and mental health issues. In this article, we investigated the prevalence of smartphone addiction among postgraduate students and evaluated its correlation with social demographics, depression, attention-deficit/hyperactivity disorder (ADHD), and nicotine dependence. Objectives The objective of this study was to investigate the prevalence of smartphone addiction among Middle Eastern postgraduate students, determine the factors associated with smartphone addiction, and estimate the incidence rate of major depressive disorder (MDD), ADHD, insomnia, and nicotine addiction among postgraduate students with smartphone addiction. Methods As part of a cross-sectional online survey, participants were given a self-questionnaire divided into six sections: Socio-demographics, Smartphone Addiction Scale (SAS), Patient Health Questionnaire (PHQ9) for Depression, Athens Insomnia Scale (AIS), the Fagerström Test for Cigarette Dependence Questionnaire (FTCd), and the adult ADHD Self-Report Scale (ASRS-v1.1). Results Of the 506 patients, 51.0% of the participants demonstrated smartphone addiction. A significant association was also observed between extensive smartphone use and MDD ( P = 0.001). Of the smokers in this study, 41.5% were addicted to smartphones ( P = 0.039). Smartphone addicts had approximately two times the chance of having insomnia (OR = 2.113) ( P = 0.013). In addition, they showcased more ADHD symptoms (OR = 2.712) ( P < 0.001). Conclusions We found a positive association among insomnia, depression, adult ADHD, and smartphone addiction, which confirms the findings reported in the previous studies. Therefore, we encourage the scientific community to further study the impacts of smartphone addiction on the mental health of postgraduate students.

Background The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence. Objective This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic. Methods This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ≥18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors. Results Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020. Conclusions Monitoring the population’s mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis. International Registered Report Identifier (IRRID) DERR1-10.2196/23748

Background: Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by the inability to sustain attention, hyperactivity, and impulsivity. Recent studies showed that it can persist in adulthood. The modification of the “Diagnostic and Statistical Manual of Mental Disorders” in its fifth edition has a significant impact on detecting adult ADHD. To the best of our knowledge, there are no studies done on adult ADHD among medical students in the Gulf region. Methodology: A cross-sectional study was conducted on 487 medical students from all academic year from February 1, 2018, until March 31, 2018, in two governmental and one private medical school in Riyadh city. Self-reported English questionnaire paper used for the study was composed of two parts; socio-demographic and adult ADHD screening scale of DSM-5 version. Results: Fifty-three students (10.9%) reported symptoms of ADHD. Concerning the prevalence and percentage, there was no noticeable difference in gender (p value = 0.364), academic year (p value = 0.666), nationality (p value = 0.379), colleges (p value=0.836), and age (p value = 0.992). History of early life ADHD was significantly associated with adult ADHD (p value = 0.012), along with student’s grade point average, mainly from a score of three and above out of five (p value = 0.024). Conclusion: Our study found a higher prevalence of ADHD among medical students compared with worldwide prevalence. This difference could be due to social and cultural factors. Those individuals may have difficulty in communication and learning which can disturb academic efficiency, lengthen their study, and even disturb

The aim of this study was to examine the role of perceived sleep quality in predicting subjective as well as objective cognitive function in adults with major depressive disorder (MDD).Adults with recurrent MDD (n = 100) experiencing a major depressive episode of at least moderate severity and age-, sex-, and education-matched healthy controls (HC) (n = 100) were recruited to participate in a clinical trial validating the THINC-integrated tool (THINC-it; NCT02508493) for cognitive function. The THINC-it includes subjective and objective measures of cognitive function. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).Compared with HC, individuals with MDD reported significantly poorer sleep quality, as assessed by domain and global PSQI scores (all P values <.05). Both perceived sleep quality (P < .001) and depression severity (P = .002) were found to independently predict impairments in subjective cognitive performance. Only perceived sleep quality predicted objective cognitive impairments (P = .017). Exploratory mediation analysis revealed depression severity to be a partial mediator of the relationship between perceived sleep quality and subjective cognitive performance (95% confidence interval [CI]: -0.56, -0.33).The results indicate that the subjective and objective cognitive impairments are differentially related to perceived sleep quality and depression severity and emphasize the importance of treating sleep disturbances in MDD.

Orexins are neuropeptides that are postulated to play a central role in the regulation of the sleep-wake cycle, appetite, affect, and reward circuitry. The objectives of the current review are to comprehensively evaluate (1) the potential role of orexins in the pathophysiology of major depressive disorders (MDD) and (2) the orexin system as a novel target in the treatment of MDD. Dysfunction of the sleep-wake cycle is observed as a central feature of MDD pathophysiology. Orexin system disturbances produce sleep-wake dysfunction, as observed in MDD. Orexin antagonists have been shown to treat insomnia effectively without disrupting normal sleep architecture in both preclinical (e.g., animal models) and clinical studies. Orexin antagonists are generally safe, well-tolerated, and associated with an acceptable long-term adverse effect profile with relatively low propensity for tolerance or dependence. Orexin antagonists have also been shown to possess antidepressant-like properties in some animal models of MDD. Extant evidence indicates that orexin-modulating treatments exert pleiotropic effects on multiple neural systems implicated in the phenomenology of mood disorders and suggests orexins as a promising target for investigation and intervention in mood disorders. To date, no human clinical trials evaluating the antidepressant effects of orexin antagonists in MDD have been completed. Given the promising results from preclinical studies, clinical trials are merited to evaluate the antidepressant effects of orexin antagonists in MDD.

Depression is one of the most common health issues impacting the world. People with severe depression symptoms are affected in their work, home, and social lives. Early diagnosis of mental illness is difficult, especially within the Arabic culture, because of the stigma of mental illness and lack of awareness in the field of psychiatry. Meanwhile, social media and its posts provide a new fertile source for mental health surveillance by people express their feelings, moods, and daily activity. Recently, the research field in detecting mental illness through social media has begun to be an exciting topic with the increase in popularity of social media platforms and the current studies in this area just covering English data. To our knowledge, this is the first study that has used Arabic data to explore depressive emotions in an online population. Our experiment, which is based on data collected from Twitter in the Gulf region, detects users who self-declared in their tweets as having been diagnosed with depression. Another set of tweets from non-depressed users was used as a standard group to construct a corpus with truth labels (depressed and non-depressed). We then built a predictive model based on supervised learning algorithms (Random Forest, Na\xEFve Bayes, AdaBoostM1, and Liblinear) to predict whether a user\x92s tweet was depressed or not. Our predictive model leveraged from an efficient features set which was extracted to cover not only the symptoms of clinical depression but also online depression-related behaviour on Twitter (e.g., interaction with trending hashtags and frequent emojis). We observed that optimal accuracy performance was with the Liblinear classifier at 87.5%.

BACKGROUND AND OBJECTIVES:This study evaluated the association between self-reported anxiety and objective/subjective measures of cognitive performance in adults with Major Depressive Disorder (MDD).METHODS:Acutely depressed subjects with recurrent MDD (n = 100) and age-, sex-, and education-matched healthy controls (HC; n = 100) between the ages of 18 and 65 completed the cross-sectional validation study of the THINC-integrated tool (THINC-it; ClinicalTrials.gov: NCT02508493). Objective cognitive performance was assessed using the THINC-it, and subjective cognitive impairment with the Perceived Deficits Questionnaire for Depression-5-item. Subjects also completed the Generalized Anxiety Disorder-7-item (GAD-7) questionnaire.RESULTS:Subjects with MDD reported significantly more anxiety symptoms, as assessed by the GAD-7, compared to HC (p < 0.001). Linear regression analysis determined that anxiety symptoms significantly accounted for 70.4% of the variability in subjective cognitive impairment, adjusting for depression severity. Moreover, subjects' ratings of the difficulties caused by their anxiety were reported as significantly more severe among subjects with MDD when compared to HC (p < 0.001). Likewise, greater self-reported difficulties with anxiety significantly predicted 57.8% of the variability in subjective cognitive impairment, adjusting for depression severity. Neither anxiety symptoms nor impairment due to anxiety symptoms predicted objective cognitive performance.LIMITATIONS:Subjects were not prospectively verified to have a clinical diagnosis of GAD. Rather, this study examined the relationships between symptoms of generalized anxiety, assessed using a brief screening tool, and subjective and objective cognitive function.CONCLUSIONS:Results from the current study indicate that adults with MDD and high levels of self-reported anxiety are significantly more likely to report experiencing subjective cognitive dysfunction.

Introduction: To determine, via narrative, non-systematic review of pre-clinical and clinical studies, whether the effect of cannabis on hepatic biotransformation pathways would be predicted to result in clinically significant drug-drug interactions (DDIs) with commonly prescribed psychotropic agents. Areas covered: A non-systematic literature search was conducted using the following databases: PubMed, PsycInfo, and Scopus from inception to January 2017. The search term cannabis was cross-referenced with the terms drug interactions, cytochrome, cannabinoids, cannabidiol, and medical marijuana. Pharmacological, molecular, and physiologic studies evaluating the pharmacokinetics of Delta(9)-tetrahydrocannabinol (Delta(9)-THC) and cannabidiol (CBD), both in vitro and in vivo, were included. Bibliographies were also manually searched for additional citations that were relevant to the overarching aim of this paper. Expert opinion: Delta(9)-Tetrahydrocannabinol and CBD are substrates and inhibitors of cytochrome P450 enzymatic pathways relevant to the biotransformation of commonly prescribed psychotropic agents. The high frequency and increasing use of cannabis invites the need for healthcare providers to familiarize themselves with potential DDIs in persons receiving select psychotropic agents, and additionally consuming medical marijuana and/or recreational marijuana.

Introduction: To determine, via narrative, non-systematic review of pre-clinical and clinical studies, whether the effect of cannabis on hepatic biotransformation pathways would be predicted to result in clinically significant drug-drug interactions (DDIs) with commonly prescribed psychotropic agents.Areas covered: A non-systematic literature search was conducted using the following databases: PubMed, PsycInfo, and Scopus from inception to January 2017. The search term cannabis was cross-referenced with the terms drug interactions, cytochrome, cannabinoids, cannabidiol, and medical marijuana. Pharmacological, molecular, and physiologic studies evaluating the pharmacokinetics of Delta(9)-tetrahydrocannabinol (Delta(9)-THC) and cannabidiol (CBD), both in vitro and in vivo, were included. Bibliographies were also manually searched for additional citations that were relevant to the overarching aim of this paper.Expert opinion: Delta(9)-Tetrahydrocannabinol and CBD are substrates and inhibitors of cytochrome P450 enzymatic pathways relevant to the biotransformation of commonly prescribed psychotropic agents. The high frequency and increasing use of cannabis invites the need for healthcare providers to familiarize themselves with potential DDIs in persons receiving select psychotropic agents, and additionally consuming medical marijuana and/or recreational marijuana.

LEARNING OBJECTIVES:After participating in this activity, learners should be better able to:• Characterize cognitive dysfunction in patients with major depressive disorder.• Evaluate approaches to treating cognitive dysfunction in patients with major depressive disorder.ABSTRACT:Cognitive dysfunction is a core psychopathological domain in major depressive disorder (MDD) and is no longer considered to be a pseudo-specific phenomenon. Cognitive dysfunction in MDD is a principal determinant of patient-reported outcomes, which, hitherto, have been insufficiently targeted with existing multimodal treatments for MDD. The neural structures and substructures subserving cognitive function in MDD overlap with, yet are discrete from, those subserving emotion processing and affect regulation. Several modifiable factors influence the presence and extent of cognitive dysfunction in MDD, including clinical features (e.g., episode frequency and illness duration), comorbidity (e.g., obesity and diabetes), and iatrogenic artefact. Screening and measurement tools that comport with the clinical ecosystem are available to detect and measure cognitive function in MDD. Notwithstanding the availability of select antidepressants capable of exerting procognitive effects, most have not been sufficiently studied or rigorously evaluated. Promising pharmacological avenues, as well as psychosocial, behavioral, chronotherapeutic, and complementary alternative approaches, are currently being investigated.

Sirtuins are NAD(+)-dependent histone deacetylases that play essential roles in cell survival, energy metabolism, inflammation, and aging; therefore, sirtuins are potential therapeutic targets in the treatment of type 2 diabetes, cancer, inflammatory and metabolic disorders, and neurodegenerative diseases. Available evidence provides the basis for hypothesizing that sirtuins 1, 2, and 3 (SIRT1, SIRT2, and SIRT3) may have a mechanistic role subserving mood disorders (i.e. downregulation) and associated co-morbidity (e.g. metabolic disorders). Specifically, the domains of general cognitive processes, as well as cognitive emotional processing may be particularly relevant to sirtuin physiology. Given the role of sirtuins in the perpetuation of circadian rhythmicity, and evidence of dysfunctional circadian cycling in mood disorders, sirtuins may be an underlying etiological factor that links circadian rhythm functionality with mood disorders. Caloric restriction, and caloric restriction mimetics (e.g. resveratrol) are all capable of upregulating sirtuin isoforms implicated in stress response syndromes. Repurposing existing treatments and/or discovery of novel agents capable of modulating sirtuin physiology may represent genuinely novel approaches for trans-diagnostic domains affected in mood disorders and other brain-based illnesses.

OBJECTIVES:To examine the role of pain on cognitive function in adults with major depressive disorder (MDD). METHODS:Adults (18-65) with a Diagnostic and Statistical Manual - Fifth Edition (DSM-5)-defined diagnosis of MDD experiencing a current major depressive episode (MDE) were enrolled (nMDD=100). All subjects with MDD were matched in age, sex, and years of education to healthy controls (HC) (nHC=100) for comparison. Cognitive function was assessed using the recently validated THINC-integrated tool (THINC-it), which comprises variants of the choice reaction time (i.e., THINC-it: Spotter), One-Back (i.e., THINC-it: Symbol Check), Digit Symbol Substitution Test (i.e., THINC-it: Codebreaker), Trail Making Test - Part B (i.e., THINC-it: Trails), as well as the Perceived Deficits Questionnaire for Depression - 5-item (i.e., THINC-it: PDQ-5-D). A global index of objective cognitive function was computed using objective measures from the THINC-it, while self-rated cognitive deficits were measured using the PDQ-5-D. Pain was measured using a Visual Analogue Scale (VAS). Regression analyses evaluated the role of pain in predicting objective and subjective cognitive function. RESULTS:A significant between-group differences on the VAS was observed (p<0.001), with individuals with MDD reporting higher pain severity as evidenced by higher scores on the VAS than HC. Significant interaction effects were observed between self -rated cognitive deficits and pain ratings (p<0.001) on objective cognitive performance (after adjusting for MADRS total score), suggesting that pain moderates the association between self-rated and objective cognitive function. CONCLUSIONS:Results indicated that pain is associated with increased self-rated and objective cognitive deficits in adults with MDD. IMPLICATIONS:The study herein provides preliminary evidence demonstrating that adults with MDD reporting pain symptomatology and poorer subjective cognitive function is predictive of poorer objective cognitive performance. THINC-it is capable of detecting cognitive dysfunction amongst adults with MDD and pain.

Olanzapine is an atypical antipsychotic medication, previously expected to be safe in terms of hematological side effects and considered an alternative choice to clozapine in patients who develop hematotoxicities. However, since olanzapine was introduced to the market many case reports have been published revealing that it could cause hematoxicity. Some of these reports also indicated that olanzapine induced agranulocytosis. Therefore, we conducted a systemic review to explore and address this issue. Electronic database searches from 1998 to 2015 yielded 35 case reports of olanzapine-induced leukopenia and three related systematic reviews. The onset of leukopenia for the majority of these case reports followed in the first month of administration of olanzapine. Moreover, more than two third of these cases never developed drug-related leukopenia before the use of olanzapine. The ages of affected individuals were 16 to 83 years old and their races were African, Caucasian, Asian, Jewish and Mediterranean. The doses of olanzapine ranged from 2.5 to 30 mg. Interestingly, olanzapine was associated with third highest incidence of neutropenia among antipsychotics. The mechanism of olanzapine-induced neutropenia is still unknown, but could be similar to clozapine because of similar chemical composition. Therefore we recommend that the guidelines regarding olanzapine need to be reconsidered and closely monitored with patients being treated with olanzapine for hematological side effects.