Administered antipsychotic pro re nata medications in psychiatric inpatients. Pre- and post-accreditation comparison

To investigate whether the mental health accreditation program drives improvements in the clinical practice of giving pro re nata [PRN] antipsychotic medications for psychiatric inpatients. This study was conducted in October 2012, a record-based pre-post assessment design in psychiatric inpatient wards at King Khalid University Hospital, Riyadh, Saudi Arabia. Data collected from a 12-month pre-accreditation period [July 2009 to June 2010] was compared with those from a 12-month post-accreditation period [July 2011 to June 2012]. The collected data identified demographics, diagnosis, number of PRN antipsychotic medications administered per patient, and indications for use. There were 177 patients during the pre-accreditation period, and 182 patients during the post-accreditation period. Before accreditation, 87% of patients were administered PRN antipsychotics and the average number of PRN antipsychotic administrations per patient was 12.10 +/- 7.0 compared with 81% of patients being administered 7.47 +/- 3.2 PRN antipsychotic medications per patient post-accreditation. Prior to accreditation, a high number of PRN antipsychotic medications were administered to patients with no specified indications [rs=0.698; p<0.001]. During the post-accreditation period, the corresponding correlation coefficients significantly declined to rs=0.465; p<0.001. Implementation of clinical practice guidelines in psychiatric inpatients significantly reduces the frequency of PRN antipsychotic medications and enhances patient safety

Evidence-based psychiatry Keeping up-to-date

As medical knowledge rapidly increases, textbooks become out-of-date whatever effort is made to ensure that they are up-to-date. The psychiatrist, without knowing how to find the best available evidence, may become out of date. Advances in clinical epidemiology and medical informatics have introduced an approach to close the gap between research and practice, thus improving the quality of patient care. This approach is called Evidence-Based Medicine [EBM]. Evidence based medicine emphasizes the examination of evidence from clinical research and de-emphasizes unsystematic clinical experience and subjective rationale. To apply evidence from the medical literature to patient care, evidence-based process involves the application of certain systematic steps. Evidence-based practice assumes that some kinds of evidence are more valid and of greater clinical applicability than others. This paper provides a brief introduction to evidence based psychiatry, its advantages, critique and suggested references that can be used to increase psychiatrist's knowledge of evidence-based psychiatry

Vaginismus treatment Hypnotherapy versus behavior therapy

To investigate the effectiveness of hypnotherapy in the treatment of vaginismus compared to behavior therapy. A consecutive sample of 36 women with vaginismus [DSM-IV criteria] referred to the out-patient psychiatry clinic at King Abdul-Aziz University Hospital in Riyadh between 1999-2003 were divided into 2 groups for either treatment on a random basis. A female psychologist independently and carefully assessed patients before and after treatment. Patients were treated until they achieved satisfactory sexual intercourse. Although both behavior therapy and hypnotherapy were successful in treating vaginismus, hypnotherapy performed better than behavior therapy in reducing the level of the wife's sex-related anxiety and in improving the husband's sexual satisfaction score. Success tended to occur faster in women treated with hypnotherapy as they received fewer treatment sessions. Women with vaginismus can be successfully treated by hypnotherapy without simultaneous treatment of their husbands. Hypnotherapy can provide an acceptable time and cost effective therapeutic tool that helps resolve vaginismus and improves sexual satisfaction in both spouses

Attitude to psychiatry three-year follow-up a cohort of Saudi medical students at their first post-graduate year

In a previous report the researcher described positive changes in the Saudi medical students' attitudes to psychiatry after psychiatry clerkship. This paper reports a three-year follow-up of the attitudes and changes in attitudes to psychiatry in the same subjects after they have chosen their specialties, using the same methods. The general attitude to psychiatry remained positive in both sexes. The participants' general attitudes to psychiatry in the middle of the first post-graduate year remained similar to those held at the end of the psychiatry clerkship. Despite the enduring favourable attitude to psychiatry there was no significant improvement in the recruitment into the specialty, with only 4% of the subjects choosing psychiatry as a specialty. There was a statistically significant increment in the percentage who agreed with the specific attitude "psychiatrists are held in poor regard by most other doctors". The study results emphasize that in Saudi Arabia, cultural attitudes to psychiatry and social as well as professional stigma act as opposing forces against recruitment of trainees in psychiatry. The implications of the finding are discussed

Physical diseases in psychiatric in-patients referral pattern

To evaluate the referral pattern of physical illnesses in psychiatric in-patients. Method: A prospective study was carried out over 12 months. The referrals from the psychiatric in-patient unit in a teaching hospital in Riyadh City were studied. Informations including demographic data, reasons for referral, specialty consulted and pattern of response were analyzed. The total consultation rate was 38.4% [81 patients]. There was more than one referral for 47 patients. The most commonly consulted specialty was medicine [69%]. New physical complaints in females significantly outnumbered known physical illness and abnormal investigations. Physical diseases in psychiatric in-patient are not uncommon. Unfortunately, physical complaints from psychiatric patients are often initially considered to be somatization, abnormal sensation, or contrived to attain a secondary gain. Results of this study may provide baseline statistics for local psychiatrists and mental health planners for better psychiatric services in the future

In-patient treatment for resistant obsessive-compulsive disorder

Obsessive Compulsive Disorder is one of the increasing psychological disorders. If not detected early and treated properly, obsessive-compulsive disorder usually becomes an incapacitating illness adversely affecting almost all aspects of the patient's life. Outpatient behavioral and pharmacotherapies frequently fail. This is a report on a severe case of obsessive-compulsive disorder that was treated as an in-patient with both behavior and pharmacotherapies, she was then followed up for 5 years with no relapse. The case reflects the importance and the need for in-patient units for severe resistant obsessive compulsive cases especially in Saudi Arabia where we have an increasing number of such cases