Healthcare seeking behavior among subjects with irritable bowel syndrome.

The behaviors exhibited by individuals who seek healthcare for irritable bowel syndrome (IBS) are numerous, varied, and sometimes controversial, and/or inconsistent. This study aims to review the factors associated with these healthcare seeking behaviors. Through a selective review of the literature, articles were identified by using the following search terms: IBS, healthcare seeking, conventional and non-conventional treatment, cultural factors, and gender differences. The roles of different factors associated with healthcare seeking are discussed.

Accuracy of referring psychiatric diagnosis.

BACKGROUND: The author examined the accuracy of the initial psychiatric diagnosis of primary medical providers requesting psychiatric consultation in a medical inpatient setting in a university hospital. METHODS: A retrospective review of 217 consecutive psychiatric consultations was conducted in which the initial diagnostic impression of primary medical providers was compared with the final psychiatric diagnosis. RESULTS: The accuracy of psychiatric diagnosis was the highest for cognitive disorders 60%, followed by depression 50% and anxiety disorders 46%, whereas the accuracy of diagnosing psychosis was 0%. CONCLUSION: Thus, the accuracy of initial diagnoses made by primary medical providers is quite variable. Factors affecting these results are discussed.

Neuropsychiatric side-effects of interferon alfa therapy for hepatitis C and their management: a review.

BACKGROUND: Interferon-Alfa (IFN-alpha) has been the mainstay of treatment for chronic hepatitis C. It has the potential to alter the course of chronic hepatitis C and prevent complications. AIMS: This review summarizes current knowledge about the presentation, mechanism, course, and treatment of neuropsychiatric problems associated with interferon alfa (IFN-alpha) treatment. METHODS: Studies were identified by computerized searches, and further references were obtained from bibliographies of the reviewed articles. RESULTS: Neuropsychiatric symptoms frequently occur in hepatitis C patients treated with IFN-Alfa. These side effects are troublesome and frequently account for dose reduction or treatment discontinuation. Sometimes, they could be serious and possibly life threatening. Frequent psychiatric evaluations of high risk individuals and, when required, early administration of antidepressants could possibly help to avoid the development of an impending depression or reduce its severity and duration and thus increase adherence to treatment. CONCLUSION: Greater cooperation between psychiatrists and hepatologists would mean less risk of having the serious side effects with more importance needs to be given to the identification of patients at risk.

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.

Shared psychotic disorder.

We describe a rare case of psychotic disorder, with unique family dynamics and management difficulties.