Referrals to psychiatric service in United Arab Emirates: an analysis of the content of referral letters

To study all psychiatric referrals by General Practitioners [GPs] to the psychiatric service at Al-Ain Hospital for 7 years starting from July 1997 till December 2003. The study examined the appropriateness of referrals and the quality of information presented in the referral document. Also, it studied the outcome of this referral including the response of the psychiatrist. The case notes of all patients referred from the Primary Health Centres to the psychiatric service of Al-Ain Hospital for the period specified were studied. The data related to the GP referral were obtained from the copy of the referral letter, in the case notes. The information included: identifying data, reason for referral, symptomatology, relevant medical history and investigations, provisional diagnosis, recommended action, and the response of the psychiatrist. The diagnosis in the referral letter was compared to the International Classification of Diseases, 10th edition, Primary Health Care version [ICD-10 [PHC]], and to the final diagnosis in the case notes for agreement. Among the whole sample of 503 GP referrals there were 309 males [61.4%] and 179 [35.6%] females and 15 [3%] missing data. The mean age was 32.8 years [SD=13.7], with mean age for UAE nationals 31.4 years [SD=15.58] and expatriates as 34.3 years [SD=11.32] with significant difference between the two groups [t=2.253, p=0.03], 74.2% expatriates males with significant difference, and 15 missing data. Analysis of the referral letters showed that Diagnosis was clearly indicated in 380 [77.2%], was not mentioned in 112 [22.8%] of the referral letters, with 11 missed data. Psychiatrists agreed with the GP diagnosis in 205 of them [41.7%], but considered diagnosis inaccurate in 175 [35.6%] of these cases. All the referred patients had been seen by psychiatrists. However, replies of the psychiatrists to the GPs referrals were made only in 29 patients [5.9%]; 4 of these replies were written and the 2 copies of the letter were kept in the file. No reply was written in 460 cases and 14 missing data. Also physical examination and investigations were not mentioned in the majority of referrals. There is poor quality of GP referral letters and obvious poor response rate of psychiatrists to the GPs. This is an indication for urgent need for intensive training to GPs advising them to include particular items of information in future referrals

Psychogenic psychosis revisited: a follow up study

Although brief and acute psychoses are usually dramatic in presentation, they usually have benign course. Studies investigating clinical features and changes in diagnosis between psychotic episodes have differed in design. However, some consistent findings have emerged. This study seeks to clarify and extend these features by describing and comparing clinical diagnostic stability in a group of subjects with first episode psychosis diagnosed as acute psychotic disorder [psychogenic psychosis] followed up for 6 years. The study comprises a retrospective evaluation of case records of 161 patients admitted for the first time with first episode psychosis. Among this group a subgroup of 69 psychogenic psychoses were followed up with special reference to stability of diagnosis within a period of 6 years. Forty-six patients [67.6%] were male, 22 [32.4%] were female and data were missing in one case-record. There was no significant statistical difference between gender and diagnosis. The mean age was 27.5 years [13-45 years]. There were criteria, which distinguish acute psychotic disorder [psychogenic psychosis]. These criteria include acute onset with short duration of untreated psychosis, precipitating factors, adjusted pre-morbid personality, no family history of mental disorder, short duration of admission, full recovery in most of cases, with no further admission. Nearly 80% of the patients have never been admitted again in 6 years time. Our findings show a high level of agreement with the original concept of psychogenic psychosis; however, these bear little relationship to the DSM-IV [1994] and ICD-10 [WHO, 1993] criteria for brief or acute psychotic disorder

Clinical characteristics of first episode psychosis: a retrospective study in AL Ain, United Arab Emirates

The primary aim of this work was to examine the socio-demographic, clinical correlates, the effect of medical treatment on the first episode psychosis in an Arabic country. A retrospective case note review, looking at first episode psychosis who were admitted to the in-patient psychiatric ward in Al Ain general hospital over 5 years. 161 patients with first episode psychosis were reviewed. In the 5-year period under the study, 161 aged 13-45 years with history of first episode psychosis were admitted to the psychiatric ward. They established a different clinical diagnoses according to ICD 10: 69 patients [42.9%] had a diagnosis of acute psychotic episode, 35 patients [21.7%] had a diagnosis of manic episode, 31 patients [19.3%] had a diagnosis of schizophrenia, 16 [9.9%] had depression with psychotic symptoms, 3 [1.9%] drug dependence, 1 [0.6%] persistent delusional disorder, and in 6 [3.7%] patients the data were missing. The mean age was 27.5 years [13-45 years] [SD=6.6], male/female ratio [1 10/49, 68.3%/30.4%]. There was a significant relationship between duration of untreated psychosis [DUP] and outcome, where the longer the DUP the more existence of residual symptoms on discharge [chi 2 =18.515, df=6, p=. 005]. In addition there was a significant relationship between social withdrawal symptom prior to admission and residual symptoms on discharge. Results of this study indicate that DUP, clinical features and type of medications may determine the outcome of first episode psychosis

Life events, Co morbidity of psychiatric disorders and physical illnessess A review of the literature

The view that co-morbidity of life events, psychiatric disorders and physical illnesses enjoys considerable support by a number of older and recent publications. This article reviews recent studies on possible etiological and contributing factors, new approaches and research difficulties, which are of particular interest for planning more effective preventive and treatment strategies. Studies were identified by means of computerized and manual searches. High rates of Co-morbidity suggest that life events, psychiatric disorders, and physical illnesses are functionally related to one another. Inclusion of patients with Co-morbid life events, psychiatric and physical disorders in neurobiological research and in clinical trials will be critical for development of effective treatment for this severely symptomatic patient's population