Joseph El-Khoury

The Valens Clinic

Opioid Substitution Treatment (OST) is a firmly established method of treating and managing dependence to opioids in Europe, the US and rest of the developed world. It has a solid evidence base and a positive safety track record. Dissemination of its practice, in parallel to the acceptance of harm reduction as an effective approach, is still timid...

The recognition of mental health needs in developing countries is growing in parallel with increased public awareness of and reduced stigma toward mental illness. With resources still limited in these countries, creating economically viable health care models is essential. These models are often adapted from already established and tested systems i...

The emergence of the Islamic State organization on the Syrian war scene has raised the role of amphetamines, and in particular the drug Captagon, in explaining the military performance and the savagery of its militants. This phenomenon has received extensive coverage in the international media. We review the evidence for it relying on available pub...

In April 2020, after decades of discussions and controversy, the Lebanese parliament voted a law legalizing the cultivation, production, and sale of cannabis for medicinal purposes. Although the law leaves several unanswered questions and awaits implementation, the symbolic nature of this step in recognizing a positive role of cannabis in the local...

The experiences of irregular combatants and the psychosocial impact of their participation in violent conflict are poorly understood in comparison to the body of research available on military veterans in developed countries. The Lebanese civil war (1975-1990) was an archetypal intra-national armed conflict, involving thousands of civilians turned...

Introduction Schizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes.The suitability of this model of care outside the western context h...

BACKGROUND: Cannabis Hyperemesis Syndrome (CHS) is a condition characterized by episodic bursts of vomiting

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Background Lebanon remains as one of the major sources of cannabis worldwide. In 2020, its government passed a legislation enabling the cultivation of local medicinal cannabis. This first study following the legislative change examines the overlapping use of cannabis for recreational/medicinal purposes and characteristics of the distinct cannabis u...

Cannabis Hyperemesis Syndrome (CHS) is a condition characterized by episodic bursts of vomiting and abdominal pain linked to cannabis use. The clinical picture mimics an acute abdomen and is often misdiagnosed, especially when the patient avoids reporting their cannabis use for legal reasons

To our knowledge this report commissionned by MENAHRA is the first to directly shed light on the mental health needs of two key populations (KPs) in the Middle East and North Africa region from a harm reduction perspective: opiate drug users and people living with Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) (PLWHA).

Schizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes. The suitability of this model of care outside the western context has not been...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Abstract. The ICD-11 developmental field study of the reliability of psychotic disorders and bipolar disorders: Results among Tunisian adult patients. As part of the revision of the diagnostic guidelines for mental, behavioral, and neurodevelopmental disorders, the World Health Organization conducted field studies to test the reliability of the Int...

Fasting during the holy month of Ramadan is one of the five pillars of Islam. Adherents to the Muslim faith are expected to abstain from drinking or eating during daylight hours. Exclusions to fasting apply, including for medical reasons. There is no consensus on the specific implications for psychiatric conditions. This qualitative study explores...

The explosion of 3,000 tons of ammonium nitrate on August 4, 2020, in the port of Beirut resulted in human tragedy and extensive property damage. As 1 of the largest man-made disasters to affect a population in peacetime, the explosion attracted global attention and support. The disaster happened in a complex socioeconomic context, even by the stan...

Psychosis has the highest economic burden among mental disorders worldwide. Our retrospective chart-based review aimed to identify factors that predict unscheduled clinical contact for patients with psychosis attending an outpatient psychiatry clinic. Participants consisted of patients with a primary diagnosis of a psychotic disorder being followed...

Background : On August 4, 2020, Beirut's port experienced one of the strongest non-nuclear explosions in history, killing approximately 200 people, displacing 300,000 persons, and injuring more than 1000 children. Methods : An online anonymous survey assessed the prevalence of probable mental health disorders (MHDs) and impact of blast-related and...

The required minimum number of psychiatric inpatient beds is highly debated and has substantial resource implications. The present study used the Delphi method to try to reach a global consensus on the minimum and optimal psychiatric bed numbers. An international board of scientific advisors nominated the Delphi panel members. In the first round, t...

Post-traumatic stress disorder (PTSD) is a stress and trauma related disorder characterized by a heightened stress-response or avoidance associated with a traumatic event. In its severe form, PTSD remains a debilitating condition causing significant disability despite the already established treatment options. 3,4-Methylenedioxymethamphetamine, or...

The multiplication of social networking sites has led to increased frequency of use among young adults. While the association with mental wellbeing is still controversial, high levels of social media use were correlated with problematic behaviours, low self-esteem and depres-sive symptoms. 'Social Media Detoxification' (Detox) is the term used to d...

Background/Objective: The most recent versions of the two main mental disorders classifications—the World Health Organization's ICD-11 and the American Psychiatric Association's DSM–5—differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is...

Background: Low- and middle-income countries (LMICs) have been consistently under-represented in the pool of contributors to academic journals on health. For the past two decades, prominent voices within the psychiatric profession have called for better representation of LMICs in the interest of advancing the understanding of mental health globally...

The Beirut port explosion on August 4, 2020, traumatized the Lebanese population. It also revealed a lack of disaster mental health preparedness in a country subject to significant political, economic, and security challenges. The Trauma Assessment and Support Clinic at the American University of Beirut Medical Center was one of many initiatives se...

Clozapine is recommended as first-line treatment for treatment-resistant schizophrenia (TRS). Despite its established position in all international guidelines, prescribing and utilization rates of clozapine have consistently been low among psychiatrists. The primary aim of the current study was to survey psychiatrists in the Middle East and North A...

Introduction Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health following years of stagnation. The mental health needs of the country for severe psychiatric disorders are underserved. Objectives The aim of our study is to describe community mental healthcare services in Lebanon and t...

Introduction On August 4th 2020, a massive port explosion shook Beirut, killing at least 200, injuring more than 6,000 people and leaving more than a quarter of a million living in unfit homes. Various factors can participate in the severity of mental health outcomes of a disaster including the number of injuries, the degree of property destruction...

We are psychiatrists based at the American University of Beirut Medical Center, one of the largest psychiatric departments in Lebanon. Since October, 2019, Lebanon has navigated through several crises. It started with unremitting political unrest, national bankruptcy, and currency devaluation. The COVID-19 pandemic complicated the situation by stre...

Torture has been illegal in most of Europe and the United States for over a century but persisted in other parts of the world. The changing geopolitical landscape has led to its resurgence in recent years. The public rejection of traditional forms of torture that rely on the infliction of physical pain has paradoxically increased the reliance on ps...

Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health over the past two decades following years of stagnation. The mental health needs of the country at primary care level and for severe psychiatric disorders are underserved. Political instability, chronic underfunding and widespread sti...

The Arab world has struggled with conflict and political turmoil for several decades, rendering its already underdeveloped mental healthcare system unable to serve the psychiatric needs of victims of violence and trauma, with consequences that extend far beyond the cessation of hostilities. This role has become incumbent on international relief age...

The framing effect in medical decision making is a type of cognitive bias that can lead a medical trainee at undergraduate and graduate level to reach a diagnosis or take action based on emotional states induced by the frame in which the information has been approached. This literature review on the framing effect in medical decision making will be...

Lebanon was one of the countries to be affected early by the COVID-19 pandemic while in the midst of political upheaval. The stress implicated by this dual challenge allowed for mental health to take a center stage, prompting a nationwide official and informal response.

Genetic and lifestyle factors influence weight changes secondary to antidepressants. However, the association between antidepressants and weight changes is seldom studied in Middle Eastern populations who have a unique genetic, lifestyle and dietary profile. This is a chart-based retrospective longitudinal study that describes the 6-month evolution...

Episodes of mania typically occur in the context of bipolar disorder, with an average age of onset of 25 years. A condition with identical symptoms, known as secondary mania, generally occurs in isolation in older adults and has an identifiable organic etiology. Here, we report a 57-year-old man who presented to the emergency department with a 3 we...

The aim of this study was to evaluate the adequacy of the then proposed International Classification of Diseases version 11 (ICD-11) diagnostic guidelines for Gender Incongruence of Adolescence and Adulthood in a sample of transgender people accessing multidisciplinary health care services at specialised organisations in Lebanon. The cross-sectiona...

Background The World Health Organization estimates that 75% of patients with mental and substance use disorders in low- and middle-income countries do not have access to the care needed. In the Arab World, approximately 100–140 million people suffer from at least one psychiatric disorder. One main criticism of classification systems has been their...

Children and adolescents are increasingly exposed to various types of media. The power of film to shape attitudes and behaviors has been widely accepted in a number of different contexts. The goal of this study was to analyze the representation of illicit drugs and alcohol in movies recently released in the United States and available to an under-1...

Mental health problems are common in Lebanon, and so are psychiatric emergencies. In order to show the characteristics of psychiatric emergencies in Lebanon along with their dispositional determinants, we conducted this retrospective, single-center, chart-review study of patients who presented to the Emergency Department between July 1, 2016 until...

The 2006 Lebanon war was the last major round of the various conflicts that have affected this countryfor half a century. Its nature, scope, and timing after a decade of relative peace, have had an enduring effect on the Lebanese psyche. At a time of renewed regional tension and a threat of possible military action in the same geographical area, we...

In this paper we report the clinical utility of the diagnostic guidelines for ICD‐11 mental, behavioural and neurodevelopmental disorders as assessed by 339 clinicians in 1,806 patients in 28 mental health settings in 13 countries. Clinician raters applied the guidelines for schizophrenia and other primary psychotic disorders, mood disorders (depre...

Background: Schizophrenia is often associated with poor clinical insight (unawareness of mental illness and its symptoms) and deficits in empathy, which are important for social functioning. Cognitive empathy has been linked to clinical insight while affective empathy and its role in insight and pathology have received mixed evidence. Methods: Inst...

Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11). The present study assessed inter-...

Background and objective: Recreational use of salvia divinorum (salvia), a potent, naturally occurring hallucinogen, is on the rise internationally. Despite the paucity of information about its long-term health effects, salvia is readily available and generally portrayed as a safe non-addictive substance. Methods and results: We report on two pa...

The association of substance abuse and psychotic disorders is of interest to clinicians, academics, and lawmakers. Commonly abused substances, such as cannabis, cocaine, amphetamines, and alcohol, have all been associated with substance-induced psychosis. Hallucinogens can induce desired psychedelic effects and undesirable psychomimetic reactions....

Nilforooshan et al [1][1] recently examined the rates and outcome of appeal against detention under the Mental Health Act 1983 for different ethnic groups. They found that Black Caribbean and White Irish groups, although lodging significantly more appeals compared with other ethnic groups (at 63%

Relevant literature was searched using MEDLINE, PsycINFO and Google in addition to Arabic search engines for information. Due to the shortage of scholarly articles on the subject, we broadened our search to publications from human rights organisation and articles in the mainstream press. We estimated the total carceral population in the member coun...

We sought to replicate in the Specialist Community Addiction Service that covers the county of Oxfordshire the audit on the prescribing of injectable opiates undertaken by White & Shearman in Cornwall.[1][1] We identified 19 patients (14 males and 5 females) on regular injectable opioid

We conducted a 1-year retrospective study of attendance at a general National Health Service psychiatric clinic in London between 2005 and 2006. We aimed to compare attendance rates between grades of doctors and identify demographic and organisational factors affecting attendance. Previous

The newly qualified doctor is often at the frontline of acute medical services and is therefore likely to be called to situations where a patient is aggressive. This article discusses the systematic assessment of such situations, including an assessment of aetiology and risk assessment. Management issues are outlined with reference to available str...

Psychiatric care in south-west Stockholm: the SHO perspective - Volume 4 Issue 1 - Joseph El-Khoury, Claire Dillon