Assessment of suicidal and self-injurious behaviours among patients with depression

The aim of this cross-sectional 1-year study was to estimate the prevalence and to identify the risk factors for suicidal and self-injurious behaviours among patients with depression. A convenience sample of 557 out- and inpatients diagnosed with mood disorders was selected from 3 treatment settings in Riyadh, Saudi Arabia. Eligible patients completed data on sociodemographic variables and the Columbia suicide severity rating scale risk assessment version. The reported prevalence of attempted suicide in the previous week was 36.6%, interrupted suicide attempt 29.8%, aborted suicide attempt 34.6% and self-injurious behaviour without suicide intent 7.7%. Concerning suicide ideation, 47.2% reported suicidal thoughts, 36.6% suicidal thoughts with methods but without a specific plan and 35.4% suicidal intent without a specific plan. Male sex, joint family type, literate education, being in employment, smoking and physical co-morbidities were significantly associated with all types of suicide behavior

Pattern of child and adolescent psychiatric disorders among patients consulting publicly-funded child psychiatric clinics in Saudi Arabia

Data about psychiatric problems among young people are scarce in the Gulf countries. This retrospective review of records describes the pattern of child and adolescent psychiatric disorders among patients consulting 3 child psychiatric clinics in Saudi Arabia during the year 2008. Most patients were referred from the public health sector [92.8%]. Psychotropic drugs were prescribed for 86.2% of patients and psychotherapy for 55.2%. Maternal perinatal complications and other psychosocial stressors were noted in almost 45.8% of cases. Family history of psychiatric disorder was reported in 31.5% of patients. Psychiatric comorbidity was noted in 40.5% of cases while physical diseases were noted in 29.9%. The outcome was classified as unstable at the last consultation in 17.9% of cases. In a linear regression analysis the only factors significantly associated with unstable outcome were a higher load of symptoms [OR 2.64] and perinatal complications [OR 2.84]

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part1: variations in drug prescribing

Rational prescribing is associated with improved safety in drug use, better quality of life for patients and cost-effective care. Medication prescribing is a relatively unexplored area of research in Saudi Arabia and until now most studies have been in the secondary and tertiary health care system. This paper is the first of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews variations in prescribing patterns and influences on physicians' prescribing behaviour worldwide and in Saudi Arabia

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 2: rational prescribing

Unlike suB-optimal prescribing rational prescribing, coupled with certain indicators, is associated with improved safety in drug use in drug for prescribing, better quality of life for patients and cost-effective care. Medication prescribing is relatively unexplored area of research in Saudi Arabia and until now most studies have been health care system. This paper is the second of 3 review articles that form the interconnected studies of prescribing patterns and medication errors in the public care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer- reviewed journals over the previous 3 decades. The paper reviews rational prescribing with its indicators suboptimal prescribing, classification of medication errors, and how to achieve quality in health care prescribing worldwide and in Saudi Arabia

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 3: prescribing errors

Medication errors are globally huge in magnitude and associated with high morbidity and mortality together with high costs and legal problems. Medication errors are caused by multiple factors related to health providers, consumers and health system, but most prescribing errors are preventable. This paper is the third of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews the etiology, prevention strategies, reporting mechanisms and the myriad consequences of medication errors

Medication prescribing pattern in primary care in Riyadh city, Saudi Arabia

Physicians' prescribing behaviour is closely linked with patient safety and this area is poorly researched in Saudi Arabia. The objective of this stulf was to analyse physicians' prescribing patterns and the adequacy of noted information in the primary health care sector in Riyadh city. All medication prescriptions from 5 public [n = 1182] and 5 private [n - 1200] health centres were collected by simple random sampling during 1 working day. Antibiotics were the most commonly prescribed drugs in both sectors. The mean number of drugs per prescription was 2.08 and 2.36 in the public and private sectors respectively. Information and instructions noted on prescriptions varied considerably between private and public health centres. Similarly the medication prescribing pattern differed across the 2 health settings. Primary care physicians in Saudi Arabia need continuing training to improve their prescribing practices

Determinants of physicians' medication prescribing behaviour in primary care in Riyadh city, Saudi Arabia

This study in Saudi Arabia explored the determinants of physicians' prescribing behaviour in primary care in Riyadh city. A self-administered questionnaire designed to explore factors influencing prescribing [sociodemographic factors; practice access to educational materials; pharmaceutical company representatives, and patients factors] was completed by 87 PHC physicians. A factor analysis of 56 variables extracted 7 factors that explained 46% of the variance. Of these, 4 components positively related to perceived good prescribing behaviour could be summarized as: clinical experience of physicians; use of educational materials for continuous updating of medical knowledge; enhanced levels of continuing medical education and willingness to involve patients in decision-making; and working as a team using pharmacists for consultation and emphasizing the role of medical education.The other 3 factors derived from the analysis were less easy to interpret and may have been statistical anomalies [or measurement errors]

Effectiveness of three interventions on primary care physicians' medication prescribing in Riyadh city, Saudi Arabia

A number of strategies have been shown to improve the quality of drug prescriptions. The objective of this study was to implement and assess the effectiveness of 3 interventions on physicians' prescribing and cost containment: training physicians about quality prescribing, regulatory and administrative measures to improve rational drug prescribing; and a multi-faceted approach using 2 these strategies plus additional elements. Three public health centres, 1 for each intervention, were randomly selected, 61 physicians were trained in drug prescribing and completed a pre- and post-training questionnaire, and 100 post-intervention prescriptions from each centre were compared. All 3 interventions effectively improved the quality of drug prescriptions and the notation of drug-related information and trainees returned positive evaluations of the training course. Whether or not physicians' improvement in prescribing will be sustained is unclear and therefore subsequent follow-up evaluations are needed

Mental and Social Health Atlas I in Saudi Arabia: 2007-08

Based on the World Health Organization's Mental Health Atlas, the first Mental and Social Health Atlas in Saudi Arabia describes the historical background of mental health and social services in the country and identifies several deficiencies in the system including infrastructure and logistics and lack of epidemiological data. There is now great progress in strategic planning for developing and improving mental health care services across the nation, with suggestions to develop psychiatric services for identified special populations, to establish community mental health care services, to improve research and training in mental health, and to update mental health annual information systems using advanced information technology

Triage systems: a review of the literature with reference to Saudi Arabia

This review evaluates some of the international literature on triage in order to provide evidencebased data for the medical community in Saudi Arabia specifically and the Eastern Mediterranean Region in general. The aim is to encourage national health planners and decision-makers to apply formal triage systems in the emergency departments of general and specialist hospitals and other relevant health settings, including primary and psychiatric care. Research and training on triage is extremely limited in Saudi Arabia and the Region and this review highlights the need for more research on triage systems and for the inclusion of training on triage in medical education programmes

Criteria for a good referral system for psychiatric patients: the view from Saudi Arabia

The development and implementation of quality referral systems reflects sound national health planning. This review appraised the data on referral systems, in particular psychiatric referrals, with special reference to Saudi Arabia. A computer search was made of relevant literature in the past 2 decades. The rate and process of referring patients through referral letters varies globally across practice settings and is initiated by an array of factors linked with health consumers, health providers and delivery systems. Referral systems, including consultation-liaison services, are an essential component of any health care organization for offering a complete range of good quality, specialized health services

Smoking patterns among primary health care attendees, Al-Qassim region, Saudi Arabia

Prevalence, sociodemographic patterns and medical co-morbidity of smoking among a cross-section of primary health care [PHC] clients in Saudi Arabia were examined. We used a 44-item semistructured questionnaire to collect data from 1752 patients at 25 randomly selected PHC centres. Percentage of smoking was 52.3%. Although 85% were adult smokers, 8.6% began smoking before age 12. Smokers gave overlapping reasons to smoke including peer pressure; non-smokers gave religious and health logics against smoking. Of all smokers, 92.8% wanted to learn cessation strategies, 11.8% were ignorant of hazards and 32.4% reported manifestations of nicotine withdrawal. Besides alcohol use [13.4%], 81.8% had co-morbid physical disease

Psychiatric co-morbidity in primary care and hospital referrals, Saudi Arabia

Psychiatric and physical morbidities among patients referred from primary health care [PHC] centres and general hospitals [GH] in Al-Qassim region were compared. Thus, 540 psychiatric referrals [GH = 138; PHC = 402] were selected randomly. Fifteen GH patients but no PHC patients were referred for admission. Psychiatrists made more diagnoses of dementia, affective and anxiety disorders, mixed anxiety-depression and somatoform disorders than clinicians and general practitioners [GPs]. Clinicians made significantly more diagnoses of acute psychoses and somatoform disorders than GPs. Physical morbidity was noted in 38.4% and 17.2% of GH and PHC referrals respectively

Drug addiction: a general review of new concepts and future challenges

Relevant papers published in peer reviewed journals in the past 2 decades were identified and screened to abstract pertinent information. Substance dependence/addiction, involving both a common brain reward mechanism and longer-lasting molecular and cellular changes, is a preventable chronic, relapsing brain disease and as such a public health problem. Physical and psychological dependence, characterized by withdrawal syndrome, are now given less weight compared with compulsive behaviour and uncontrolled use of drugs in the comprehension of addiction. The challenging components of drug addictions, including counteradaptation, sensitization, abstinence, craving and relapse need further neurobiological and non-neurobiological exploration and understanding, which may be possible through the use of advanced imaging and genetic techniques and animal models of drug addiction together with relevant human studies

Psychotropic drugs prescriptions in Al-Qassim Region, Saudi Arabia

Psychotropic drugs prescriptions for patients attending psychiatric outpatient clinics were studied. Of the 52,168 prescriptions written in 1996, 18,265 were systematically, randomly selected and evaluated. Incomplete prescriptions were found; the data missing included duration of treatment [18.75%], sex [9.25%], age [8.75%] and diagnosis [7.50%]. Antipsychotics [33.1%], antidepressants [23.2%], anticholinergics [22.0%] and anticonvulsants [12.9%] were the most frequently prescribed drugs. Polypharmacy [85%] was the predominant mode of practice. The most common diagnoses were mood [23.1%], anxiety [17.7%] and schizophrenic [16.2%] disorders. Medical education and quality monitoring programmes are suggested to improve the quality of psychotropic prescriptions and modify multiple pharmacotherapy practice

Patterns of psychiatric disorders among elderly patients [more than 50 years] attending psychiatric outpatient clinics at the Buraidah mental health hospital, Buraidah, Al-Qassim, Saudi Arabia

200 psychiatric outpatients over 50 years of age were recruited for studying patterns of psychiatric disorders by using multiple psychiatric rating scales. It was revealed that family type, occupation and social class were significantly correlated with some clusters of mental disorders. Both sexes unexpectedly equally utilized the mental health services, 49,5% of patients had different psychopathologies with an onset of below 50 years of age, and finally 48% of probands showed physical comorbidity. In addition to the discussion of findings and limitations of this study, some clinical implications were highlighted and certain recommendations were also suggested

Sociodemographic correlates, pattern and comorbidity of drug abuse among psychiatric patients

Though there is no published report, apparently the extensive mass media campaign and the establishment of 3 specialized drug abuse centers in Saudi Arabia are indicative of emergence of drug abuse/addiction problems. We carried out a preliminary study to evaluate the demographic parameters, pattern, and comorbidity of drug abuse among 120 male mental patients in a controlled fashion by using different testing materials. The computer analysis of data revealed that relatively single and/or disruptive marital life, poor social class, unskilled job and/or unemployment and several psychosocial stressors were significantly associated with drug abuse. The multiple drug abuse patterns and a variety of mental disorders also eharacterized these patients. It is suggested that the tentative data of this research might stimulate interest in other researchers to study further the different aspects of drug abuse/addictions in Arabian peninsula

Utilization of maternal health services [MHS]: a comparative study between residents and nomads

The patterns of utilization of maternal health services [MHS] by Qubah residents [n = 66, 64.71%] and mobile nomads [n = 36, 35.29%] have been compared. Patients were studied who attended the Qubah Primary Health Care Centre [PHCC] in the month of Rajab, 1409H [7 February 1989 to 7 March 1989], a peak time for nomads to aggregate in the surrounding area of Qubah which has two small villages [higars] nearby. The relevant data including age, weight, distance travelled, details regarding registration at PHCCs, antenatal, natal and postnatal follow-up, and laboratory tests performed, were recorded on a semistructured proforma. Following computer data analysis, it was revealed that nomadic women were comparatively underweight [48.9 + 7.14 vs 53.46 + 10.1], had low levels of Hb [11.18 + 1.91 vs 12.33 + 0.41], travelled a long distance [38.89% >40 km], and were underregistered [13.89% vs 1.52%]. They underutilized the MHS prenatally [mean visits 2.10 vs 10.6], and postnatally [mean visits, 0.72 vs 2.8], attended Qubah PHCC at an advanced stage of gestation [61.11% vs 7.58%], had higher rates of home or hut deliveries [52.78% vs 9.09%]. It was concluded that nomadic women, to a significant extent lagged behind in utilizing the MHS. In the light of this pilot study, we propose some recommendations which include the establishment of new health units in higars, with the feasibility of opening maternity waiting homes, upgrading the skills of traditional birth attendants, and last but most important a larger multicentre study