Feras Al Saif

The health care system is one of the key areas where people with mental illnesses could experience stigma. Clinicians can hold stigma attitudes during their interactions with patients with mental illness. To improve the quality of mental health services and primary care, evidence-based practices should be disseminated and implemented. In this study, we evaluated the attitudes of health care providers in Bahrain toward people with mental illness and adoption of evidence-based practice using the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) and Evidence-Based Practice Attitude Scale (EBPAS). We conducted a cross-sectional study across 12 primary health care centers and a psychiatric hospital (the country’s main mental health care facility). A self-report questionnaire was distributed among all health care providers. A total of 547 health care providers participated, with 274 from mental health services and 273 from primary care services. Results of the OMS-HC indicated differences between both main groups and subgroups. Regression model analysis reported significant outcomes. There was no statistical difference found between both groups in EBPAS scores. A weak but statistically significant negative association was reported between both scales. Participants showed varying stigma attitudes across different working environments, with less stigma shown in mental health services than in primary care services. Providers who were more open to adopting evidence-based practices showed less stigma toward people with mental illness. Comparing our findings with previous research showed that health care providers in Bahrain hold more stigma attitudes than other groups studied. We hope that this study serves as an initial step toward future campaigns against the stigma of mental illness in Bahrain and across the region.

Misophonia is still an unclassified disorder and means literally “strong dislike (hate) of sounds”. In this paper, we present a case report of an adolescent female who had misophonia that was complicated with two non-fatal suicide attempts. She presented with anxiety features and started to follow up for three years. Assessment of the level of misophonia for a year using Amsterdam Misophonia Scale (A-MISO-S) showed an extreme degree soon after the second suicide attempt. Initially, psychotherapy was noticed to be ineffective due to her poor motivation. Escitalopram was added to the management plan and improvement was reported in the depressive symptoms and obsessional thoughts of misophonia but were intolerable eventually because of the weight gain. Therefore, it was switched into Fluoxetine and Bupropion but six weeks later she attempted her second suicide by Bupropion overdose. At that point, the psychiatrist, the patient and her parents agreed to continue therapy with non-psychopharmacological treatment. Gradually she became more engaged in psychotherapy sessions after noticing its effectiveness. It was concluded that significant improvement of misophonia was reported when she was treated by Selective Serotonin Reuptake Inhibitors (SSRI) namely Escitalopram or Fluoxetine, motivated in psychotherapy sessions, adapted good coping strategies, decreased her dysfunctional challenging behaviour, rejoined social interaction and activity in her life, was more insightful and aware about her illness and developed self-acceptance.