Mental disorders pose a substantial global burden, particularly among conflict-affected populations. This study aimed to examine gender-stratified, item-level networks of anxiety, depression, and posttraumatic stress disorder (PTSD) among Palestinian refugees in Egypt following the 2023 war on Gaza. A cross-sectional study was conducted among 558 Palestinians aged > 18 years displaced to Egypt. Anxiety, depression, and PTSD were assessed using the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Impact of Event Scale-6, respectively. Bayesian network analyses were applied to identify central symptoms and the strongest within- and cross-diagnostic associations. In the male network, suicidal ideation and loss of energy emerged as the most central symptoms. The strongest cross-diagnostic association was observed between anticipatory fear and depressed mood. Within diagnostic domains, the strongest associations were found between uncontrollable worry and excessive worrying (anxiety), loss of energy and appetite change (depression), and war-related intrusive thoughts and hypervigilance (PTSD). In the female network, psychomotor agitation or retardation and suicidal ideation were the most central symptoms. The strongest cross-diagnostic association was between trouble relaxing and anhedonia. The strongest within-domain associations were observed between feeling anxious and being easily annoyed (anxiety), loss of energy and depressed mood (depression), and war-related intrusive thoughts and reminders of war (PTSD). Identifying gender-specific core symptoms and both within- and cross-diagnostic associations in this vulnerable population is crucial to inform targeted interventions and reduce comorbidity.

Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric condition. While selective serotonin reuptake inhibitors (SSRIs) are a standard treatment, many patients experience an inadequate response to monotherapy. For individuals with treatment-resistant OCD (TR-OCD), antipsychotic augmentation is a commonly utilized pharmacological strategy. This review aimed to systematically review the literature and conduct a frequentist network meta-analysis (NMA) to evaluate the comparative efficacy, safety, and tolerability of first-, second-, and third-generation antipsychotic augmentation in adults with TR-OCD. A systematic search was conducted from database inception to March 2026. Double-blind randomized controlled trials (RCTs) and observational studies evaluating antipsychotic augmentation of ongoing SRI therapy in adults with TR-OCD were included. The primary outcome was the mean change in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score. The secondary outcomes included categorical treatment response (Y-BOCS reduction ≥ 35%) and tolerability. Pairwise meta-analyses utilized an inverse-variance random-effects model with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. The NMA established an empirical treatment hierarchy using surface under the cumulative ranking curve (SUCRA) probabilities. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Forty-three studies (22 RCTs and 21 observational studies) encompassing 890 patients were included. Pairwise meta-analysis of the RCTs demonstrated that, as a class, antipsychotic augmentation was significantly superior to placebo in reducing continuous Y-BOCS scores (standardized mean difference (SMD) = -0.49; 95% CI: -0.99 to -0.00; p < 0.05) and increasing the odds of categorical response (odds ratio (OR) = 2.38; 95% CI: 0.97 to 5.86). The NMA revealed a distinct hierarchy of efficacy: haloperidol exhibited the largest effect compared to placebo (SMD = -1.34; SUCRA = 0.799), followed by olanzapine (SMD = -0.80; SUCRA = 0.596), risperidone (SMD = -0.74; SUCRA = 0.625), and aripiprazole (SMD = -0.57; SUCRA = 0.532). The evidence for quetiapine (SMD = -0.45; SUCRA = 0.450) and paliperidone (SMD = -0.22; SUCRA = 0.356) was less robust and indistinguishable from that of the placebo. Although haloperidol was highly efficacious, its use was limited by poor tolerability. Risperidone and aripiprazole demonstrated the most optimal balance of robust anti-obsessional efficacy and acceptable tolerability. Preliminary data highlighted the potential of third-generation agents, such as brexpiprazole. Antipsychotic augmentation is a highly effective, evidence-based strategy for managing TR-OCD. Based on comparative efficacy and tolerability profiles, risperidone and aripiprazole are the preferred augmenting agents. The routine use of quetiapine should be reconsidered because of its marginal superiority over placebo. Future large-scale active-comparator RCTs are essential to define the long-term metabolic burden and evaluate novel agents to advance precision psychiatry in refractory OCD.

Background: The public harbors adverse perceptions of individuals with mental illness. The global prevalence of mental health illnesses has consistently risen. Untreated mental illness in high school adolescents can result in social, behavioral, and academic problems. Methods: A respondent-driven sample of 716 high school teachers working in Najran city was surveyed. The participants completed questionnaires assessing their mental health knowledge and Perceived Devaluation and Discrimination. Results: Almost two-thirds of participants had adequate knowledge. The highest knowledge scores were found in the items related to the effectiveness of medication and psychotherapy. Schizophrenia was the most recognized mental health condition, followed by bipolar disorder and depression (mean scores 4.3, 4.0, 3.9, respectively). Almost two-thirds of the study participants (73.6%) had high perceived stigma in the total score of the PDD scale. The highest scores of perceived stigma were found in the scale items related to hiring a qualified person with severe mental illness (86.3%) and being close friends with a person with severe mental illness (85.6%). Participants with adequate knowledge had more perceived social stigma than those with inadequate knowledge (77% versus 66%). There were statistically significant associations between Stigma-related mental health knowledge and socio-demographic characteristics of the study participants (p < 0.05). Conclusions: This study found that, despite the foundational level of knowledge, particularly regarding treatment effectiveness, gaps exist in understanding help-seeking behaviors. Socio-demographic factors play a role in shaping mental health literacy among high school teachers in Najran city.

Background and Objectives: Psychiatric symptoms and multidimensional impulsivity may be associated with the clinical and functional heterogeneity of substance use disorders (SUDs), but evidence from Saudi Arabian treatment populations remains limited. This study examined concurrent associations with a study-specific aggregate of Addiction Severity Index (ASI-5) interviewer severity ratings. Materials and Methods: This cross-sectional study included 204 adults receiving inpatient detoxification or residential rehabilitation services in Najran, Saudi Arabia. The seven ASI interviewer ratings were summed as an aggregate score. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and impulsiveness using the Barratt Impulsiveness Scale-11 (BIS-11). Analyses included age- and sex-adjusted analyses of covariance, false-discovery-rate correction, bootstrap Spearman correlations, an a priori multivariable model with HC3 robust confidence intervals, and sensitivity analyses addressing content overlap, multicollinearity, influential observations, functional form, and the bounded outcome distribution. Results: The mean age was 34.4 ± 7.3 years; 78.9% were male. The aggregate score was 26.33 ± 4.15. It correlated strongly with BPRS total (ρ = 0.874, 95% CI 0.827–0.908) and moderately with BIS-11 total (ρ = 0.590, 95% CI 0.494–0.669). In the primary model (adjusted R² = 0.864), age, BPRS total, motor impulsiveness, and non-planning impulsiveness were conditional correlates of greater aggregate burden; male sex was inversely associated, and polysubstance use was not. BPRS remained associated after exclusion of the ASI psychiatric domain. Separate impulsivity-domain and BIS-11 total models, 5000-resample bootstrap analysis, median regression, and fractional-logit analysis retained the principal psychiatric and impulsivity directions. The polysubstance coefficient varied across sensitivity models. Conclusions: Psychiatric symptom burden and selected impulsivity dimensions were concurrently associated with higher study-specific aggregate ASI interviewer severity scores. Integrated psychiatric and impulsivity assessment may help characterize patients with greater concurrent multidomain clinical burden; the aggregate score should not be interpreted as a validated global severity or prediction measure.

Background: The ongoing war on Gaza has a devastating impact on Palestinians, particularly on their psychological well-being. Aims: To assess mental health disorders and coping strategies among Palestinians displaced to Egypt during the 2023 Gaza war. Methods: A cross-sectional study included Palestinian refugees older than 18 years. Impact of Event Scale-6, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Coping Strategies Inventory-Short Form were used to assess posttraumatic stress disorder (PTSD), anxiety, depression, and coping mechanisms, respectively. Results: Among the 558 participants, 62.2% were females, with a mean age of 33.91 ± 11.84 years. Prevalence rates of PTSD, anxiety, and depression were 37.5%, 94.1%, and 94.8%, respectively. Emotion disengagement was the most adopted coping strategy. Multiple linear regression showed that PTSD was positively associated with being female, anxiety, depression, and the use of problem engagement, problem disengagement, and emotion disengagement coping strategies. Very good financial status and difficulty accessing healthcare were negatively associated with PTSD. Anxiety was associated with older age, being female, difficulty finding a job, war-related injury, PTSD, depression, and problem disengagement, while emotion engagement was protective. Depression was associated with a family history of mental illness, housing difficulties, emotion disengagement, anxiety, and PTSD, while problem engagement and being female were protective. Conclusions: Context-sensitive psychosocial interventions that strengthen coping strategies are essential to alleviate the psychological burden among this vulnerable population.