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Psychiatric comorbidity in neurological disorders: Towards a multidisciplinary approach to illness management in the United Arab Emirates

Taoufik Alsaadi1, Seada Kassie1*, Ola Mohamed Ali1, Khaldoun Mozahem1, Safana Al Fardan2 and Ahmed M. Ahmed1
  • 1 American Center for Psychiatry and Neurology, United Arab Emirates
  • 2 Shaikh Khalifa Medical City, United Arab Emirates

Background: A multidisciplinary approach to illness management and education in primary care has been instrumental to managing the epidemic of psychiatric comorbidity in physical illness. While efforts are being seen in other parts of the world highlighting the need, such data is lacking in the Gulf region. Among the few studies that looked at prevalence and correlates of depression and anxiety in primary care, one study found 30% of patients with epilepsy showed clinically significant symptoms of depression and anxiety (Alsaadi et al, 2015). Similarly, a study looking at psychiatric comorbidity in patients with type-2 diabetes found a 12.5% prevalence rate of mental health concerns, and a significant correlation between patients’ mental health status and their primary diagnosis (Sulaiman et al., 2010). Two independent studies looking at the impact of depression and anxiety on health-related quality of life among patients with a) epilepsy and b) multiple sclerosis found that depression and anxiety, along with the use of anti-depressants were among the highest predictors of patients’ health-related quality of life (Alsaadi et al., 2017a; Alsaadi et al., 2017b). Limited research in this area accounts for why medical practice in the region remains behind in the implementation of a multidisciplinary approach. As such, the current study aimed at bridging this gap by investigating the prevalence of depression and anxiety among patients seeking neurology services at a local outpatient center offering both psychiatric and neurological services. The current study capitalized on the availability of these conjoint services to determine the prevalence of mood and anxiety disorders in patients seeking neurological services in the unique population of the UAE. Moreover, the study looked at whether depressive and anxiety symptoms are detected by the attending neurologist based on patient self-report, the severity threshold at which referral to psychiatric services does occur and whether referred patients attend these services. Method: At the end of their visit to the neurology clinic at the American Center for Psychiatry and Neurology, Abu Dhabi, 395 patients were invited to complete the Patient Health Questionnaire-9 item (PHQ-9), which assesses depressive symptoms and the Generalized Anxiety Disorder- 7 item questionnaire (GAD-7) which assesses anxiety symptoms. Referral to psychiatry/psychology services by the neurologist and patient attendance were then recorded. SPSS v.22 was used to analyze collected data. Descriptive statistics was done on the questionnaires to determine a) proportion of patients scoring in the clinically significant range, b) proportion of those patients referred to psychiatric services, and c) proportion of those referred who attended psychiatric services. Additionally, further analysis was done to determine the relationship between symptom severity and referral, and again between symptom severity and attendance to psychiatry/psychology services. Results: A total of 395 (F 55.2%, M 44.8%) patients ranging between ages 18 and 64 (M = 36.14, SD = 9.71) visiting the neurology clinic at the American Center for Psychiatry and Neurology were enrolled in the study between September 2016 and November 2017. Descriptive analysis was carried out for the following variables: sex, nationality, ethnicity, patient status, primary diagnosis, severity of psychiatric symptoms, referrals to psychiatric services, and psychiatric treatment. Of those enrolled, 102 (25.8%) had primary diagnosis of headache (73.5% migraine with and without aura and 26.5% tension-type headache), 91 (23.1%) had epilepsy, 19 (4.8%) had multiple sclerosis, and the rest 184 (46.3%) had a variety of conditions classified under ‘other neurological disorders’. Of the total 395 patients, 140 (35.4%) showed clinically mild to severe symptoms of psychiatric disorders, namely depression and anxiety. Seen individually, 154 (39%) patients showed mild to severe symptoms of clinical depression, while 137 (34%) patients showed mild to severe symptoms of generalized anxiety disorder. Of the 140 with symptoms of psychiatric disorders, 47 (33.6%) were referred to psychiatric services available at the center by their attending neurologists. There was a total of 67 (44%) patients receiving psychiatric treatment at the time of data analysis, with and without a referral from their attending neurologists. Pearson’s Chi-square tests were carried out to observe the relationship between clinically significant psychiatric symptoms and referrals to psychiatric services, as well as the relationship between primary diagnoses and psychiatric diagnosis / referrals to psychiatric services. We observed a very significant association between severity of psychiatric symptoms and referral to psychiatric services (X2 (1) = 24.96, p < .001). Seen separately, there was also a significant association between symptoms of clinical depression and referral to psychiatric services (X2 (4) = 10.86, p < .05), as well as a very significant association between symptoms of generalized anxiety disorder and referral to psychiatric services (X2 (4) = 18.77, p < .001). Conclusion: This study investigated the prevalence of depressive and anxiety symptoms across neurological complaints in patients of this specialized service in the UAE. Our results lend credence to previous studies which had similar rates of psychiatric comorbidity (Ansseau et al., 2004; Carson et al., 2006; Katon et al., 2011, Pruebl et al., 2006). Our finding that patients with migraine-type headache having higher rates of psychiatric comorbidity supports the results of Jette et al., 2008. Based on our findings, 33.6% referral rate and 47% attendance rate to psychiatric services is a promising start, but more needs to be done in delivering integrated and standardized care to patients. We argue that in medical facilities where multidisciplinary services are not available, the rates of referral would be much lower than what we found in a facility that is geared towards providing integrated patient care. The results shed light on the clinical profile of patients in this region and potentially support the need for integrated collaborative medical services. Moreover, findings have important implications on health care policies pertaining to resource distribution and funding.

Acknowledgements

The authors would like to thank Dr. Mubashira Hashmi, Consultant Neurologist, for her collaboration in informing and encouraging her patients to participate in the study. We would also like to thank Ms. Haya Qadri and Ms. Narjes Al Rashid for their assistance in data collection and data entry.

References

Alsaadi, T., El Hammasi, K., Shahrour, T. M., Shakra, M., Turkawi, L., Almaskari, B., … Raoof, M. (2015). Prevalence of depression and anxiety among patients with epilepsy attending the epilepsy clinic at Sheikh Khalifa Medical City, UAE: A cross-sectional study. Epilepsy & Behavior : E&B, 52(Pt A), 194–9. http://doi.org/10.1016/j.yebeh.2015.09.008
Alsaadi, T., Kassie, S., El Hammasi, K., Shahrour, T.M., Shakra, M., Turkawi, L., … Raoof, M. (2017a). Potential factors impacting health-related quality of life among patients with epilepsy: Results from the United Arab Emirates. Seizure, 53, 13-17. doi: 10.1016/j.seizure.2017.10.017. Epub 2017 Oct 28. (Impact factor: 2.448; Google Scholar h-5 index:32)
Alsaadi, T., El Hammasi, K., Shahrour, T.M., Shakra, M., Turkawi, L., Nasreddine, W., … Raoof, M. (2017b). Depression and anxiety as determinants of quality of life in patients with multiple sclerosis - United Arab Emirates. Neurology International, 9, 75-78. (Google Scholar h-5 index:11)
Ansseau, M., Dierick, M., Buntinkx, F., Cnockaert, P., De Smedt, J., Van Den Haute, M., & Vander Mijnsbrugge, D. (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders, 78(1), 49–55. http://doi.org/10.1016/S0165-0327(02)00219-7
Banks, S. M., & Kerns, R. D. (1996). Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychological Bulletin, 119(1), 95–110.
Bruce, T. O. (2008). Comorbid depression in rheumatoid arthritis: Pathophysiology and clinical implications. Current Psychiatry Reports, 10(3), 258–264. http://doi.org/10.1007/s11920-008-0042-1
Carson, a J., Ringbauer, B., MacKenzie, L., Warlow, C., & Sharpe, M. (2000). Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department. Journal of Neurology, Neurosurgery, and Psychiatry, 68(2), 202–206. http://doi.org/10.1136/jnnp.68.2.202
Feinstein, A. R. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23(7), 455–468. http://doi.org/10.1016/0021-9681(70)90054-8
Ferrari, S., Galeazzi, G. M., Mackinnon, A., & Rigatelli, M. (2008). Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses. Psychotherapy and Psychosomatics, 77(5), 306–14. http://doi.org/10.1159/000142523
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133(4), 581–624. http://doi.org/10.1037/0033-2909.133.4.581
Jette, N., Patten, S., Williams, J., Becker, W., & Wiebe, S. (2008). Comorbidity of migraine and psychiatric disorders - A national population-based study. Headache, 48(4), 501–516. http://doi.org/10.1111/j.1526-4610.2007.00993.x
Katon, W., Maj, M., & Sartorius, N. (2011). Depression and Diabetes. John Wiley & Sons. Retrieved from https://books.google.com/books?hl=en&lr=&id=hBnmzG1QP5YC&pgis=1
Organization, W. H. (2008). Integrating Mental Health Into Primary Care: A Global Perspective. World Health Organization. Retrieved from https://books.google.com/books?hl=en&lr=&id=vdMayQOW4kkC&pgis=1
Rosner B. Fundamentals of Biostatistics. 7th ed. Boston, MA: Brooks/Cole; 2011.
Sartorius, N. (2013). Comorbidity of mental and physical disorders: a main challenge to medicine in the 21st century. Psychiatria Danubina, 25 Suppl 1(1), 4–5. http://doi.org/10.1016/S0924-9338(12)74058-0
Sulaiman, N., Hamdan, A., Tamim, H., Mahmood, D.A., & Young, D. (2010). The prevalence and correlates of depression and anxiety in a sample of diabetic patients in Sharjah, United Arab Emirates. BMC Family Practice, 11, 80. doi:10.1186/1471-2296-11-80
Tellez-Zenteno, J. F., Patten, S. B., Jette, N., Williams, J., & Wiebe, S. (2007). Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia, 48(12), 2336–2344. http://doi.org/EPI1222 [pii] 10.1111/j.1528-1167.2007.01222.x

Keywords: Psychiatric comorbidity, Depression, Anxiety, neurological disorders, Illness management, multidisciplinary approach, integrated collaborative medical services, United Arab Emirates

Conference: 3rd International Conference on Educational Neuroscience, Abu Dhabi, United Arab Emirates, 11 Mar - 12 Mar, 2018.

Presentation Type: Poster Presentation

Topic: Educational Neuroscience

Citation: Alsaadi T, Kassie S, Mohamed Ali O, Mozahem K, Al Fardan S and Ahmed AM (2018). Psychiatric comorbidity in neurological disorders: Towards a multidisciplinary approach to illness management in the United Arab Emirates. Conference Abstract: 3rd International Conference on Educational Neuroscience. doi: 10.3389/conf.fnhum.2018.225.00010

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Received: 27 Feb 2018; Published Online: 14 Dec 2018.

* Correspondence: Ms. Seada Kassie, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates, research.officer@americancenteruae.com