Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health.
A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted.
Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses.
Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.
Many books and other published recommendations provide a large, sometimes excessive amount of information to be included, and of mistakes to be avoided in research papers for academic journals. However, there is a lack of simple and clear recommendations on how to write such scientific articles. To make life easier for new authors, we propose a simple hypothesis-based approach, which consistently follows the study hypothesis, section by section throughout the manuscript: The introduction section should develop the study hypothesis, by introducing and explaining the relevant concepts, connecting these concepts and by stating the study hypotheses to be tested at the end. The material and methods section must describe the sample or material, the tools, instruments, procedures and analyses used to test the study hypothesis. The results section must describe the study sample, the data collected and the data analyses that lead to the confirmation or rejection of the hypothesis. The discussion must state if the study hypothesis has been confirmed or rejected, if the study result is comparable to, and compatible with other research. It should evaluate the reliability and validity of the study outcome, clarify the limitations of the study and explore the relevance of the supported or rejected hypothesis for clinical practice and future research. If needed, an abstract at the beginning of the manuscript, usually structured in objectives, material and methods, results and conclusions, should provide summaries in two to three sentences for each section. Acknowledgements, declarations of ethical approval, of informed consent by study subjects, of interests by authors and a reference list will be needed in most scientific journals.
Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.
We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.
404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.
Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.
Clozapine is an effective antipsychotic medication licenced for the management of treatment resistant schizophrenia. Due to its non-selective pharmacology, it has a broad range of side effects. Nocturnal enuresis secondary to the use of clozapine has been documented in the literature but may be overlooked, the link between drug and symptom being clinically unnoticed. Patients may not mention urinary symptoms due to supervening psychosis, co-existing symptomatology, embarrassment or shame. By raising awareness of the phenomenon, early recognition and patient support may improve compliance with clozapine medication, and consecutively, overall mental health. Consequently, this systematic review investigates the prevalence of nocturnal enuresis secondary to clozapine use.
A literature search on clozapine and nocturnal enuresis was used to identify the relevant papers. Papers providing the prevalence data on Clozapine associated nocturnal enuresis were selected for data extraction.
47 papers were initially identified. Eight papers focused on the prevalence of clozapine associated nocturnal enuresis (CANE). Point prevalence (nocturnal enuresis at the time of assessment), 1-month prevalence and episode prevalence (nocturnal enuresis since beginning of clozapine) were given. Papers included patients with schizophrenia, schizoaffective disorder, bipolar affective disorder and psychotic depression, taking clozapine medication. The prevalence of CANE ranged from 10–42%. Point prevalence was 21–27%, 1-month prevalence was 10–39% and episode prevalence was 15–42%. Clozapine was more likely to cause nocturnal enuresis compared to other psychotropic medication.
The prevalence of CANE may be greater than previously thought. However, in order to determine an accurate prevalence of clozapine associated nocturnal enuresis, larger studies with strict inclusion criteria, common definition of diagnosis and prevalence are required. By establishing an accurate prevalence, physician awareness can be improved, and patients can becounselled on the risk of developing the side effect, thus improving early identification and reducing discontinuation rates.
Guarana (Paullinia cupana) from the Sapindaceae family, native to the Amazon basin, is a natural stimulant herb that can be found in popular energy drinks, pharmaceutical shops or local herb shops. With the use of natural health products increasing, guarana has gained a fair amount of popularity in the past years. In this systematic review, we examined the effects of guarana supplementation on cognitive performance. A secondary objective was to compare guarana with caffeine on cognitive performance.
Searches were made in PubMed using the terms ‘Guarana’ or ‘Paullinia cupana’. Filters focused on Controlled Clinical trials. Inclusion criteria were met by studies using interventions with guarana, while focusing on guarana’s effects on cognition. Participants needed to be young, healthy adults. Studies not published in English or Greek were excluded. The last date of our search was March 7, 2019.
A total of 29 studies were identified and screened. After screening, 17 studies were excluded. The remaining 12 studies were found eligible for data extraction. After reading the full text of the 12 studies, 3 studies were excluded. In the end, 9 studies were found eligible for our systematic review (n = 369 participants). In these studies, guarana showed to improve reaction time and accuracy of performance at cognitive tasks. No significant differences were found when comparing guarana with caffeine.
Guarana seems to improve reaction time and accuracy of performance at tasks, but no significant effects were found when compared with caffeine. High quality randomized controlled clinical trials with a low risk of bias are needed to further study the herb.
Both football (also called association football or soccer) and mental health disorders have a global impact on the lives of billions of people. Football has been used to approach and support subjects with or at risk of mental health disorders. However, it is not clear if football itself has any beneficial effect on the mental health of players, fans or spectators. Consequently, the aim of the current systematic review was to examine if playing or watching football impacts on the frequency of mental health problems in people who are involved in playing or watching the game.
We performed a systematic review on the relationship between football and mental health disorders. A total of 662 abstracts were screened initially. We identified 17 relevant papers assessing the prevalence of mental health disorders in current and previous football players, referees or spectators.
The prevalence and 12 months incidence of mental health problems in active and retired professional players and referees were similar to or higher than those found in the general population, possibly as response to osteoarthritis, severe injuries, career dissatisfaction, low social support and poor employment status after retirement. Studies in adolescent amateurs and spectators indicate that playing and watching football games may negatively affect subjective mental health, even though qualitative studies indicate mental health benefits of playing or watching football.
Players, referees and spectators are unlikely to present with fewer mental health problems than other members of society as a result of their involvement with football. It appears that some of the infrastructure that supports resilience in mental health such as a sense of inclusion, shared purpose and positive peer identification might be developed by playing in or supporting a team. Strategies that may use the assumed positive aspects of football need to be validated before implementation of large projects.