Munchausen syndrome by proxy and child's rights.

Munchausen syndrome by proxy (MSBP) is an extreme form of child abuse in which perpetrators induce life-threatening conditions in their children. A case of MSBP is described in detail. Difficulties in diagnosis and management in this part of the world are presented. Until now, no national legal guidelines exist in the Kingdom of Saudi Arabia (KSA) to child abuse in general and MSBP in particular. Urgent guidelines, policies, and legal system are required in the KSA.

Parental attitudes toward the prescription of psychotropic medications for their children.

OBJECTIVE: To explore parental attitudes towards the prescription of psychotropic medication for their children. METHOD: A questionnaire built to collect socio-demographic data of parents and their attitudes was distributed among parents. RESULTS: One thousand and ten questionnaires were filled by parents. Fathers who completed the questionnaire were double the number of mothers. Eight hundred and eighteen parents (84.3%) agreed to the dispensing psychotropic medication to their children if necessary. About 83.5% preferred to start with psychotherapy before trying medication. Fathers are more than twice likely than mothers to agree to the use of psychotropic drugs. Older parents more easily agreed to give their children psychotropic drugs. Parents who used psychotropic drug themselves were more likely to agree to the use of psychotropic drug by their children. Having a child with a psychiatric illness is the most significant factor in making parents accede to giving children psychotropic medication. Other factors such as pressure from schools and the side effects of drugs could also modify decision of parents. CONCLUSION: Although most parents agreed to give their children psychotropic drugs if necessary, they preferred to start with psychotherapy sessions before giving them the drugs. Fear and worries about such issues as side effects of drugs or addiction should be considered. Pressure from school should also be considered when deciding on drug therapy.

Assessment of pediatricians' need for training in child psychiatry.

BACKGROUND: Psychosocial problems are common health concerns in children. Therefore, it is essential for pediatricians to be able to identify psychiatric disorders. This depends on the knowledge, practice and attitudes towards psychiatric disorders in childhood. METHODS: A constructed questionnaire of items about knowledge, practice and attitudes of pediatricians toward psychiatric disorders in childhood was used. Four hundred and fifty questionnaires were distributed and collected from pediatricians in seven main governmental hospitals in Riyadh over a period of three months (between March 1 and May 30 2005). Findings were analyzed statistically. RESULTS: About 88.8% of the samples had not had any training in child psychiatry during their residency. Forty-eight percent were hesitant in diagnosing psychiatric disorders in children, 76.5% were not confident enough to treat these children, 48.5% were not confident enough to follow them up after being managed by a child psychiatrist and 49.9% were not confident to treat common side effects of psychotropic medications. About 88.8% of the pediatricians thought that pediatricians needed training in child psychiatry during pediatric residency programs. CONCLUSION: A significant number of pediatricians reported a lack of training in child psychiatry during residency programs. This has an adverse impact on their knowledge, attitudes and possibly practices in dealing with childhood psychiatric disorders.

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.

Survey of inpatients child and adolescent psychiatric referrals in a teaching hospital in Saudi Arabia.

OBJECTIVE: To answer the question of which specialties utilize the service of child and adolescent liaison psychiatry and what are the problems that are likely to bring a child or an adolescent to the attention of psychiatry. METHODS: The case records of all inpatient children and adolescents younger than 18 years, who were referred to the psychiatric team at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 6 years between July 1992 and July 1998, were retrospectively reviewed in regard to sociodemographic data, referring specialties and reason for referral. RESULTS: Seven percent of referred patients were younger than 18 years. Most were Saudi nationals. Females outnumbered males. Most of the referrals were by the neurologists, endocrinologists and gastroenterologists. The most common reasons for referral were behavioral disturbances and absence of physical findings that could explain the complaint. CONCLUSION: Low utilization of child and adolescent liaison psychiatry, reflecting the ability of pediatricians and physicians to recognize psychiatrically disturbed children and adolescents compared to adults, may explain the small number of referrals.