Development and initial validation of the cannabis-related psychosis risk literacy scale (CPRL): a multinational psychometric study

BACKGROUND

Public education efforts to address and reduce potential harms from cannabis use in Arab countries are either slow or inexistent, and do not follow the steadily increasing trends of cannabis use in Arab youth. Several decades of research on substance use, it can be suggested that being aware of, and knowing about, psychosis risk related to cannabis can at least limit the consumption of the substance. Motivated by a lack of measures specifically designed to measure literacy about cannabis-related psychosis risk in younger populations, and based on an extensive literature review, we aimed to create and validate a new self-report scale to assess the construct, the Cannabis-related Psychosis Risk Literacy Scale (CPRL), in the Arabic language.

METHOD

A cross-sectional study was carried-out during the period from September 2022 to June 2023, enrolling 1855 university students (mean age of 23.26 ± 4.96, 75.6% females) from three Arab countries (Egypt, Kuwait and Tunisia).

RESULTS

Starting from an initial pool of 20 items, both Exploratory Factor Analysis and Confirmatory Factor Analysis suggested that the remaining 8 items loaded into a single factor. The scale demonstrated good internal consistency, with both McDonald omega and Cronbach's alpha values exceeding 0.7 (omega = 0.85 / alpha = 0.85). The CPRL showed measurement invariance across gender and country at the configural, metric, and scalar levels. Concurrent validity of the CPRL was established by correlations with less favourable attitudes towards cannabis (r = -.14; p <.001). In addition, higher literacy levels were found in students who never used cannabis compared to lifetime users (4.18 ± 1.55 vs. 3.44 ± 1.20, t(1853) = 8.152, p <.001).

CONCLUSION

The newly developed CPRL scale offers a valid and reliable instrument for assessing and better understanding literacy about cannabis-related psychosis risk among Arabic-speaking young adults. We believe that this new scale is suitable as a screening tool of literacy, as an instrument for measuring the effect of public education interventions aimed at promoting cannabis-related psychosis risk literacy among young people, and as a research tool to facilitate future studies on the topic with a wider application.

Moderating effect of alexithymia between problem gambling and psychotic experiences in university students

BACKGROUND

Most of the young individuals with problem gambling (PG) or psychotic experiences (PEs) are less prone to seek medical help. Therefore, community-based studies investigating the relationship between these entities in non-clinical young people across a continuum of severity are warranted. To this end, the present study proposes to advance knowledge on the mechanisms that potentially underlie the association between PG and PEs, by examining the role of a potential moderator, i.e. alexithymia, in this relationship.

METHODS

A total of 399 participants enrolled in this study (mean age = 21.58 ± 3.20 years) participated in an online cross-sectional survey. The South Oaks Gambling Screen (SOGS), the Prodromal Questionnaire-Brief (PQ-B), and the Toronto alexithymia scale (TAS-20) were used.

RESULTS

Thirty-three (8.3%) participants had problem-gambling, whereas 13 (3.3%) were probable pathological gamblers. Moderation analysis results adjusted over confounders (age, household crowding index, marital status, personal history of mental disorder, other illegal drug use) showed that the interaction PG by alexithymia (p = .018) was significantly associated with PEs scores. At moderate (Beta = 1.93) and high (Beta = 3.38) levels of alexithymia, more PG was significantly associated with more PEs scores.

CONCLUSION

Findings suggest that GP may have a different impact on PEs depending on the individual's level of alexithymia. As such, both alexithymia and gambling behavior should be considered in the clinical assessment of young people who present with PEs, which can help in implementing more tailored and individualized treatment plans.

Schizotypal traits in a large sample of high-school and university students from Tunisia: correlates and measurement invariance of the arabic schizotypal personality questionnaire across age and sex

BACKGROUND

The main goal of the present study was to examine the characteristics of schizotypal traits and their correlations with genetic (i.e., family history of mental illness), demographic (i.e., age, sex), environmental (e.g., income, urbanicity, tobacco/alcohol/cannabis use), and psychological (i.e., personal history of mental illness other than psychosis) factors in Tunisian high-school and university students. Our secondary goal was to contribute the literature by examining the factor structure and factorial invariance of the Arabic Schizotypal Personality Questionnaire (SPQ) across sex and age (adolescents [12-18 years] vs. young adults [18-35 years]) groups.

METHOD

This was a cross-sectional study involving 3166 students: 1160 (36.6%) high-school students (53.0% females, aged 14.9 ± 1.8); and 2006 (63.4%) university students (63.9% females, aged 21.8 ± 2.3). All students were asked to complete a paper-and-pencil self-administered questionnaire containing sociodemographic characteristics as well as the Arabic version of the SPQ.

RESULTS

The total sample yielded total SPQ scores of 24.1 ± 16.6 out of 74. The SPQ yielded good composite reliability as attested by McDonald's omega values ranging from .68 to .80 for all nine subscales. Confirmatory Factor Analysis indicated that fit of the 9-factor model of SPQ scores was acceptable. This model is invariant (at the configural, metric and structural levels) across sex and age. Except for "Odd or eccentric behavior", all schizotypy features were significantly higher among female students compared to males. Multivariable analyses showed that female sex, being a university student, lowest family incomes, tobacco use, and having a personal history of psychiatric illness were significantly associated with higher positive, negative and disorganized schizotypy subscales scores.

CONCLUSION

Future research still needs to confirm our findings and investigate the contribution of the identified factors in the development of clinical psychosis. We can also conclude that the Arabic SPQ is appropriate for measuring and comparing schizotypy across age and sex in clinical and research settings. These findings are highly relevant and essential for ensuring the clinical utility and applicability of the SPQ in cross-cultural research.

Hospitalizations in psychiatry during the month of Ramadan: A study at the Tunisian mental health hospital

BACKGROUND

Muslims fast each year during the Holy Month of Ramadan. This rite has major socio-cultural consequences. The circadian rhythms, energy expenditure, body temperature and biological clock are also influenced by Ramadan fasting. The impact of fasting on patients with mental disorders has been little studied. The aim of this study was to assess the number of hospitalizations in psychiatry during Ramadan compared to the other months of the lunar year.

METHOD

A cross-sectional and retrospective study was conducted at Razi hospital, the psychiatric hospital in Tunis. The following data over the five lunar years (1434-1438) was checked for: The monthly and the annual number of hospitalizations in the different departments of Razi mental health hospital in Tunis as well as the monthly and annual rates of different legal modalities of admissions.

RESULTS

An important decrease in the number of hospitalizations during Ramadan was observed each year followed by a constant increase during the following month.Ramadan was the only lunar month to have had a consistently below-average number of admissions. There has been a significant increase in the mean number of hospitalizations per month over the years. A general trend towards an increase in the proportion of enforced hospitalizations has been noted.

CONCLUSION

Ramadan stands out not only on a religious but also on a social level. Our results add support to the usefulness of research on mental health and Ramadan in the psychiatric community.

Evaluation of Religious Coping in Tunisian Muslim Women with Newly Diagnosed Breast Cancer

Studies evaluating religious coping in Arab-Muslim populations are few. We aimed to evaluate religiosity and religious coping in a sample of breast cancer women, and to analyze the association between religiosity, religious coping, depression, anxiety, cancer clinical data, and sociodemographic data in our patients. A cross-sectional and descriptive study was conducted over a 4-month period in 61 newly diagnosed breast cancer women. We used the following scales: The Depression Anxiety Stress Scales (DASS-21), the Arabic-Brief Religious Coping Scale (A-BRCS) and the Arabic Religiosity Scale. The majority of participants (98.4%) had a moderate to high level of religiosity. A weak correlation was found between religious coping scores and stress, depression, and anxiety scores. Our patients had high scores of positive religious coping, with a mean score of 26.13 out of 28 and used more positive coping than negative coping to cope with the cancerous disease. High levels of affective religiosity were the main predictive factor of positive religious coping. Therapies should reinforce the positive religious coping patterns of breast cancer patients, and detect a possible resort to negative religious coping that may negatively affect the patients' quality of life.

Sexual dysfunction in the elderly: Prevalence and impact on quality of life

BACKGROUND

Sexual functioning is a major component of the overall human wellbeing. However, data on the sexual disorders among the elderly remain few.

AIM

Determine the prevalence of sexual dysfunction among 100 elderly Tunisian subjects and evaluate the impact on quality of life and depression.

RESULTS

The rate of sexual dysfunction was 88% without significant gender differences. Erectile dysfunction was the most common disorder in men (84.2%). Disorders of sexual arousal and pain were the most frequent disorders in women. The presence of sexual dysfunction was correlated with worse quality of life scores (p <0.001). A statistically significant correlation was not found with the depression score.

CONCLUSION

The improvement of the quality of life among the elderly should include systematic sexual dysfunction assessment and management. Sexual education programs should be carried out.

[Cannabis use in subjects at ultra high risk for psychosis]

Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis.