[ heart, mind and brain]

It has been a general observation that in many cultures throughout history, the heart has been considered the source of emotions, passion and wisdom. However, scientists in the past emphasized the role of the brain in the head, to be responsible for such experiences. Interestingly, recent studies explored physiological mechanisms by which the heart communicates with the brain, thereby influencing information processing, perceptions, emotions and health. These studies provided the scientific basis to explain how and why the heart affects mental clarity, creativity and emotional balance. Also research indicates that the heart is far more than a simple pump. The heart is, in fact a highly complex, self-organizing information processing centre with its own functional "brain" that communicates with and influences the cranial brain via the nervous system, hormonal system and other pathways. These influences profoundly affect brain function and most of the body's major systems. In this review, I shall try to summarize and integrate the interesting findings in this area

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