Quality of psychiatric referrals in Saudi Arabia. A structural equation modeling approach

This study seeks to model proposed causal relationships between the quality of psychiatric referral letters, and its indicators, linked to the features of the referred patient, referring physician, and practice setting. This study was executed at Buraidah Mental Health Hospital, Saudi Arabia, in the year 2000-2002. Data regarding 18 independent variables underlying 3 latent constructs and one dependent variable represented by quality of psychiatric referral letter score [outcome] was derived from patient files, physician training records, and 540 psychiatric referrals. Structural equation modeling was used to analyze the data for examining proposed causal relationships between the quality of psychiatric referral letters, and its potential predictors. The structural equation modeling analysis revealed a reasonably good fit of the proposed model to the data based on various fit indices. The tested model explained 67% of the variance in the quality of psychiatric referral letters. The referring physician characteristics [experience, education, and psychiatric training] and features of the referral setting [nature of setting and referral letters-administrative information] were highly significant indicators of quality of psychiatric referral letters, which in turn was negatively predicted by patient features including severity of the mental illness. Despite some caveats, the quality of psychiatric referral letters is accurately predicted by 3 latent constructs represented by referring physician skills, nature of the setting, and patient socio-clinical features

Premenstrual manic disorder: review of literature, case report and the efficacy of trifluoperazine

A selective review of literature revealed only a few case reports of premenstrual mania, hereto referred as premenstrual manic disorder [PMMD]. The anamnesis of a woman who developed manic episodes, one week before each menstrual cycle that used to remit after the onset of menstruation, is described. The continuing use of trifluoperazine satisfactorily improved her premenstrual manic symptoms and also prevented the subsequent premenstrual manic relapses. In addition to proposing tentative research criteria of PMMD, its underlying etiological mechanisms together with treatment perspectives are discussed comprehensively

Pharmacotherapies of addiction

Millions of drug addicts worldwide require proper treatment together with good quality care. This article aims to critically review the psychopharmacology of drug addictions. MEDLINE was systematically searched for studies describing drug treatment of addictions. Numerous studies were obtained and grouped according to the drug used to treat addictions. Although there are many effective antiaddictive drugs in the therapeutic armamentarium of drug addictions, a great number of patients tend to develop poor drug compliance, multiple relapses, and continue to suffer from chronic addictions coupled with negative biopsychosocial consequences. Aside from enhancing the public awareness of the devastating effects of drug addictions through regular and effective mass media campaigns, scientific efforts should be continued in order to develop new antiaddictive drugs with better clinical profiles for the treatment of patients with addictions

comparison of psychiatric referrals within the teaching hospital with those from primary care and general hospitals in Saudi Arabia

This study aims at examining the pattern of psychiatric referrals with particular reference to [1] age and gender [2] source of referrals and [3] diagnosis of referred patients within a teaching hospital. Method: Four hundred and twenty seven referrals [n = 427] for psychiatric consultation within KKUH were selected prospectively by systematic randomization over a period of one year, and were compared with a general hospital [n = 138] and primary health care [n = 402] psychiatric referrals to a mental health facility. The age of referred patients across the three settings differed significantly and the male patients were slightly over-represented in the teaching hospital referrals. Pediatric clinics in the reaching hospital constituted significant sources of psychiatric referrals as compared to the general hospitals. Schizophrenic disorders and acute psychoses were significantly less among teaching hospital referred patients, whereas anxiety and mood disorders were much more common among teaching hospital and primary care patients. The number of personality disorders diagnosed in teaching hospital settings was significant. Conclusions: In Saudi Arabia, sources of psychiatric referrals and diagnostic patterns of mental disorders differ across the three levels, and this is comparable to international research on psychiatric referrals. Besides exploring other aspects of referral process, researchers at the three settings should carry out follow-up studies to assess the impact of psychiatric consultations on the global outcome of referred consultees

Smoking among male psychiatric outpatients in Saudi Arabia

The prevalence rate of smoking among psychiatric patients has been shown to be higher than that among the general population, and this may have several neuropsychiatric implications. This cross-sectional study examines the prevalence, sociodemographic variables and pattern of smoking among psychiatric outpatients in Saudi Arabia. Patients and Over a period of 18 months [January 1996 to June 1997], 505 outpatients from five different hospitals were randomly selected to participate in the study. It was observed that 292 patients [57.83%] were current smokers, 199 [39.4%] were nonsmokers and 14 patients [2.77%] were ex-smokers. Besides revealing certain attitudes towards smoking and religious antismoking notions, it was observed that unemployment, low education status, rural background, and drug abuse were significantly associated with smoking. The prevalence rate of smoking revealed in this study is consistent with international data, and probably has implications similar to those reported in other studies. This study also found certain patterns of tobacco use in psychiatric outpatients characterized by certain sociodemographic variables and drug abuse

Datura induced delirium: a report of two cases

The native herbal plants belonging to the Solanaceous family are found worldwide including Saudi Arabia. Though the various parts of these plants are used as herbal medicines in the treatment of a variety of diseases, some of them are toxic to humans and animals. We report two cases who treat themselves with cooked Datura leaves for common cold but developed toxic features suggestive of peripheral and central anticholinergic syndromes, in particular delirium. Besides discussing different aspects of Datura poisoning, it is recommended that clinicians working in emergency departments of general and psychiatric hospitals should take relevant history of herbal plant consumption in patients who present with acute delirium, in order to make a correct diagnosis and give specific treatment

Datura Induced delirium: a report of ewo cases

The native herbal plants belonging to the Solanaceous family are found including Saudi Arabia. Though the various parts of these plants are used as herbal medicines in the treatment of a variety of disease, some of them are toxic to humans and animals. We report two cases who treat themselves with cooked Datura leaves for common cold but developed toxic features suggestive of peripheral and central anticholinergic syndrome, in particular delirium. Besides discussing different aspects of Datura poisoning, it is recommended that clinicians working in emergency departments of general and psychiatric hospitals should take relevant history of herbal plant consumption in patients who present with acute delirium, in order to make a correct diagnosis and give specific treatment