Heroin addiction in Bahrain: 15 years experience.

This study describes the development and outcome of a new treatment programme for the management of heroin addiction in Bahrain. The problem reached its peak in the early 1980s with several reported deaths and with the involvement of many disciplines in the overall response. In 1983, treatment of all addicts was restricted by law to the government psychiatric hospital. The newly established specialized drug unit was overwhelmed by the number of patients seeking treatment. The lack of sufficient resources and suitably trained staff forced the unit to adopt an outpatient maintenance therapy approach for most of its clients. In 1987, a new comprehensive treatment programme was introduced that relies on a clear philosophy, safe detoxification (using objective scales for withdrawal manifestations) rather than maintenance therapy, followed by psychological and social rehabilitation. A national committee for drug addiction was formed and an intensive programme of education was started at all levels. The results indicate an initial increase at inpatient level but a marked drop of outpatient attendance. The use of the Opioid Objective Withdrawal Manifestations Scale (OOWMS) revealed that only a small number of our patients developed moderate or severe signs of withdrawal that required detoxification, and the rate of dispensed controlled medication was reduced by 99%. The effect of this approach is discussed, with special reference to the need for a collaborative effort from all disciplines in planning, implementing, continuously evaluating and modifying the national programmes for handling the serious problem of addiction.

Development of a comprehensive treatment program for chemical dependency at Al Amal Hospital, Dammam.

An experience in developing a treatment program of addiction in an Arabic Muslim Society. The three major waves of knowledge and methodology are reviewed in historical perspective. General description of Al Amal Hospital, Dammam, K.S.A, and the three phases which the hospital treatment program underwent. Drug therapy was the main line of treatment in the first phase, which resulted in a massive consumption of controlled drugs exposing patients to iatrogenic dependence. The second phase introduced a wider concept of treatment using a bio-psycho-social model in the context of the 12 steps program of the AA. This approach did not reflect positively on patients' care due to the resistance of both patients and staff. The third phase addressed the causes of this resistance and formulated the basis for a comprehensive treatment program for addiction that relies on a clear philosophy and defined treatment stages. A multitude of treatment components were introduced and monitored by a daily clinical program audit. During the three phases, hospital records showed a progressive decrease in the amount of medications consumed (> 90%) and dropouts (24%-2.8%). The overall number of patients completing the treatment program markedly increased and although the average daily census dropped, there was, in fact, an increase in the number of voluntary patients.

Diagnostic agreement in psychiatry. A comparative study between ICD-9, ICD-10 and DSM-III-R.

A random sample of 100 new patients referred consecutively to the psychiatric hospital was assessed using the Arabic translation of the PSE. An abstract form was designed to include all PSE scores as well as the necessary extra data to make ICD-9, ICD-10, and DSM-III-R diagnoses. Kappa correlation was calculated for inter-rater and intra-rater reliability. Overall reliability and reliability of each major psychiatric diagnosis were compared between the three systems. The use of the PSE helped in achieving good agreement between Arab psychiatrists for all the three systems, but ICD-10 was found to have the highest reliability figures both for three-digit and four-digit psychiatric diagnoses.

Zuclopenthixol: a new generation of antipsychotic drugs. An open clinical trial.

Fifteen patients (20-49 years of age) with mania or acute psychosis were treated with zuclopenthixol acetate (Clopixol, Acuphase). One injection of 75-100 mg produced significant amelioration of psychotic symptoms with minimal side effects. The duration of action of the drug was found to be about 72 hours.