Schizophrenia relapse in relation to drug treatment.

OBJECTIVE: To assess and compare, prospectively, schizophrenia relapse in relation to neuroleptic medication in long term maintenance therapy. METHODS: All schizophrenic patients who met the DSM-IV criteria attending King Khalid University Hospital psychiatry outpatient clinic, Riyadh, Kingdom of Saudi Arabia in January 1994, and who fulfilled the inclusion criteria of the study, were assessed at baseline using the brief psychiatric rating scale (BPRS), quality of life scale and the extrapyramidal rating scale, and at each relapse and 6 weeks after treatment of the relapse and followed for 10 years after being allocated to one of 3 groups of neuroleptic medications depot (group A), conventional (group B) and atypical, clozapine (group C). A data collection form including sociodemographic data and other clinical indices was also completed for the patients. RESULTS: Seventy-six schizophrenic patients met the DSM-IV diagnostic criteria, but only 59 patients fulfilled the inclusion criteria of the study and 4 patients quit the study. The mean age was 27.45 years and 63.6% were males and 98.2% were Saudis. There was a statistical significance of the BPRS scores before and after relapse for groups A and C, but not for group B. The relapse rates at one year, 2 years, 3 years, and 5 years were in the range 13.3-34.6% for groups A and C but much higher at 35.7-85.7% for group B. CONCLUSION: Relapse rate in schizophrenia can be markedly reduced by effective maintenance neuroleptic treatments adhered to by the psychiatrist leaving more room for further reduction of relapse by implementing other measures such as lowering the expressed emotion, psychoeducation and rehabilitation. Further long-term large sample research is needed to affirm this.

Establishing a consultation-liaison psychiatry service. Impact on clinical indices.

OBJECTIVE: To show prospectively the impact of establishing a consultation-liaison (C/L) psychiatry model on the consultation clinical indices. METHODS: A structured, organized model of C/L psychiatry was established in 1990 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia and all clinical indices of the psychiatric consultations were compared prospectively over the first 3 years after January 1990 with those over the previous 2 years retrospectively before January 1990. RESULTS: Three hundred and two patients were referred over 3 years after January 1990, group A and 99 patients were referred over the 2 years before January 1990, group B and the male to female ratio were similar in both groups 1:1.99 and 1:2.1. Referred cases were found more to be females, married and living in urban areas and referred from the Department of Medicine. Positive influences of establishing the C/L service were; nearly double rate of referral, more selectivity of cases, more referred cases for assessment of competence and with past psychiatric history, and more patients referred with informed consent. Depressive disorder was more common in both groups. CONCLUSION: A well structured C/L psychiatry model, with clearly defined aims, has had a definite positive impact on the clinical indices of the psychiatric consultations promoting close cooperation for the excellence of patient care. This opens room for future research to explore specific developments in proposed models of C/L psychiatry.

Gilles de la Tourette syndrome treated effectively with clozapine.

A report of Gilles de la Tourette syndrome in a 16-year-old male and a 20-year-old female from the Kingdom of Saudi Arabia, illustrating difficulties in diagnosis, comorbidity and management. A successful trial of clozapine therapy after failure of conventional treatments is reported over a period of more than 2 years and discussed.