ABSTRACT
Consultation-liaison psychiatry has emerged as an important sub-specialty in the general hospital setting during recent years as a result of psychiatric acute wards moving into these hospitals. This has inspired the need for better structured research to establish its relevance and effectiveness. We, therefore, carried out a prospective cohort study at King Fahad General Hospital. We report the interaction of sociodemographic, clinical and diagnostic factors, time lag of referral and diagnostic ability of referring physicians. A total of 206 patients were referred over a period of 6 months. Sensitivity and specificity of the diagnostic skills of the referring doctors were found to be generally poor, particularly for anxiety.
Subject(s)
Mental Disorders/diagnosis , Practice Patterns, Physicians'/organization & administration , Psychiatric Department, Hospital/organization & administration , Psychiatry/organization & administration , Referral and Consultation/organization & administration , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Child , Clinical Competence/standards , Female , Health Services Needs and Demand , Health Services Research , Hospitals, General , Humans , Interdepartmental Relations , Male , Medical Staff, Hospital/education , Medical Staff, Hospital/standards , Mental Disorders/epidemiology , Mental Disorders/therapy , Middle Aged , Prospective Studies , Psychiatry/education , Saudi Arabia/epidemiology , Sex Distribution , Socioeconomic FactorsABSTRACT
To assess the attitude and knowledge of physicians and patients towards psychiatry, we asked 115 referring doctors and 188 referred patients to complete questionnaires. We examined the results along with the referral rates to try to identify factors that may affect a consultation-liaison psychiatry service. Generally, knowledge was poor and attitudes towards psychiatry negative in both groups. This negatively influenced the referral rates and reflected the lack of integration of psychiatry and medicine at the training level. This is an indication that psychiatrists need to work in collaboration with hospital doctors to integrate psychiatry into medicine at all levels and emphasizes the priority of education of hospital staff, patients and the community in consultation-liaison psychiatry.
Subject(s)
Attitude of Health Personnel , Attitude to Health , Health Knowledge, Attitudes, Practice , Medical Staff, Hospital , Mental Disorders/psychology , Psychiatry/standards , Clinical Competence/standards , Educational Status , Health Care Surveys , Health Services Needs and Demand , Hospitals, General , Humans , Medical Staff, Hospital/education , Medical Staff, Hospital/psychology , Mental Disorders/diagnosis , Mental Disorders/therapy , Negativism , Psychiatric Department, Hospital , Psychiatry/education , Quality of Health Care/standards , Referral and Consultation/standards , Saudi Arabia , Self Efficacy , Stereotyping , Surveys and QuestionnairesABSTRACT
The case records of patients receiving ECT at King Khalid University Hospital over a 10-year period were reviewed for all aspects of ethical and technical administration of ECT. The audit of 127 patients showed some deficiencies in the early years: no seizure monitoring, no training or education for staff (particularly psychiatrists and anaesthetists), and the use of atropine as a premedication for all patients. Recently, regular education and staff training have been organized and seizure timing regularly monitored. Use of an ECT machine with EEG monitoring and the systematic and scaled monitoring of complications is recommended. Results show the necessity of ECT auditing, including an unbiased external audit for effective monitoring of the practical administration of ECT. Similar audits in other mental health institutions in Saudi Arabia are recommended.
Subject(s)
Electroconvulsive Therapy/standards , Adolescent , Adult , Clinical Competence/standards , Conscious Sedation/adverse effects , Conscious Sedation/methods , Conscious Sedation/standards , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/methods , Female , Hospitals, University , Humans , Inservice Training/standards , Male , Medical Audit , Medical Staff, Hospital/education , Middle Aged , Retrospective Studies , Saudi ArabiaABSTRACT
The case records of patients receiving ECT at King Khalid University Hospital over a 10-year period were reviewed for all aspects of ethical and technical administration of ECT. The audit of 127 patients showed some deficiencies in the early years: no seizure monitoring, no training or education for staff [particularly psychiatrists and anaesthetists], and the use of atropine as a premedication for all patients. Recently, regular education and staff training have been organized and seizure timing regularly monitored. Use of an ECT machine with EEG monitoring and the systematic and scaled monitoring of complications is recommended. Results show the necessity of ECT auditing, including an unbiased external audit for effective monitoring of the practical administration of ECT. Similar audits in other mental health institutions in Saudi Arabia are recommended
Subject(s)
Clinical Competence , Conscious Sedation , Hospitals, University , Inservice Training , Medical Audit , Medical Staff, Hospital , Retrospective Studies , Electroconvulsive TherapyABSTRACT
OBJECTIVE: The objective of this study was to validate an Arabic version of the General Health Questionnaire (GHQ-28) in a primary care setting in Saudi Arabia. METHODOLOGY: A total of 60 Saudi patients selected by means of systematic random sampling were asked to fill out the GHQ-28 Arabic version. The psychiatrist interviewed all patients using the Arabic version of the Clinical Interview Schedule (CIS). RESULTS: The best cut-off level for the GHQ-28 indicating best trade-off between sensitivity and specificity was 4/5, where the validity values were, sensitivity; 72%, specificity; 74%, positive predictive value; 72%, negative predictive value; 74% and misclassification rate; 27%. The correlation coefficient was r = +0.61 and the Spearman's Rank-difference correlation was rs = +0.57. The area under the ROC Curve was 69%. The cut-off point 4/5 in this study is the same as recommended by others in primary care settings. Although the validity parameters are relatively low, they are within the range found by other studies in USA, UK and developing countries. This supports the suggestion to develop an Arabic Screening Questionnaire based on the translated GHQ with the addition of culturally specific items. CONCLUSION: The GHQ-28 Arabic Version is a valid instrument that may be of great help to primary care doctors in improving detection of psychiatric morbidity and in epidemiological research.
ABSTRACT
Upper airway obstruction can mimic bronchial asthma. A particular type results from psychogenic dysfunction of the vocal cord, and presents as bronchial asthma or organic upper airways obstruction. If not recognized, ineffective and potentially harmful therapy is given instead of focusing on the underlying psychopathology. We report three Saudi females with this condition, in whom polygamy and a large family system created associated social stress. Spirometry with a flow volume loop showed characteristic features, and in all three this test was the most important clinical tool that led to the correct diagnosis. Clinicians should perform spirometry and flow-volume loop tests routinely in patients presenting with asthmatic symptoms, and look for clues suggestive of this condition, including a psychosocial assessment.
