Reasons for referral, intervention approaches and demographic characteristics of clients with intellectual disability attending adult psychiatric outpatient services in the Kingdom of Bahrain.

BACKGROUND: Relatively little information is available regarding the use of psychiatric services by individuals with intellectual disability (ID) in Arab countries. The current study aimed to identify (1) the reasons for referral; (2) demographic characteristics of individuals referred; (3) previous contact with child psychiatric services; (4) psychiatric diagnoses; (5) level of ID; (6) nature of interventions; and (7) patterns of medication usage in individuals attending a specialist psychiatric service for individuals with an ID in the Kingdom of Bahrain. METHOD: Case file analysis was used. Files that recorded attendance at the specialist service within a specific calendar year were selected. A total of 537 files were available for review and 79 contained records indicating the individual had been seen within the year. RESULTS: The primary referral reason to adult psychiatric services was the presence of behavioural disturbance. Pharmacological intervention was the dominant treatment choice and no individual was recommended for psychological/behavioural intervention. Psychiatric diagnosis was not recorded in over 90% of cases. CONCLUSION: Services in the Kingdom of Bahrain for individuals with ID rely exclusively on pharmacological approaches for the treatment of behavioural disorders. Implications for best practice guidelines are discussed.

Papillary thyroid cancer in Saudi Arabia. Clinical, pathologic, and management characteristics.

During a 3-year period, 233 patients with papillary thyroid cancer were seen at King Faisal Specialist Hospital (KFSH) (79% were female; 94% were national subjects). Pathology revealed 88% pure papillary carcinoma and 12% mixed papillary and follicular carcinoma, 7% microfocus, 18% well encapsulated, 24% capsular invasion, and 51% soft tissue invasion. Thirty percent of patients who had initial surgery not done at KFSH compared with 93% of patients who had initial surgery done at KFSH had an I-123 24-hour uptake < 5%. One hundred seventeen patients required completion thyroidectomy at KFSH for significant residual thyroid tissue, 56% of those had residual papillary carcinoma. The amenability of papillary thyroid cancer for cure necessitates the optimization of management at the national level. In Saudi Arabia, papillary thyroid cancer presented in an advanced stage, especially in males as manifested by the large primary tumor size, advance pathologic staging, and distant metastases at the time of presentation. Findings at second surgery, showed significant residual disease.

Influence of age and sex in modulating TSH level in primary hypothyroidism.

Previous studies addressing the interaction of age and sex with the function of the hypothalamic-pituitary-thyrotrophs axis yielded conflicting results, due in part to inability to control for the effect of variable free thyroid hormone levels. We studied the effect of age and sex on TSH levels in patients with severe primary hypothyroidism who have essentially undetectable plasma thyroid hormone levels. The TSH levels were measured in 116 thyroid cancer patients four weeks after the withdrawal of thyroxine therapy in preparation for radioidine scan/treatment. All patients has a TSH >/= 30 mU/L (normal = 0.2-5) and a free T4 < pmol/L (normal = 10-25). Thirty males and 86 females with a mean age (+/- SD) of 40 +/- 16 (range 6-89 years) were studied on up to four hypothyroid episodes, with a total of 191 episodes. The TSH level during the first hypothyroid episode correlated significantly with the TSH level during subsequent episodes (first episode versus second episode, r = 0.7, P = 0.0001; first versus third episode, r = 0.6, P = 0.03). There was a significant negative correlation between age and TSH level (r = -0.24, P = 0.0009) that persisted when only the first hypothyroid episode was considered (r = -0.23, P = 0.01), or when only males (r = -0.32, P = 0.02) or only females (r = -0.23, P = 0.005) were considered. Means of TSH levels in males and females were not significantly different (130 verus 114 mU/L, respectively; P = 0.28). We conclude that age but not sex may modulate the sensitivity/responsiveness of the hypothalamic-pituitary thyrotroph axis to primary hypothyroidism.

A study of 875 cases of thyroid cancer observed over a fifteen-year period (1975-1989) at the King Faisal Specialist Hospital and Research Centre.

Thyroid cancer (TC) is a common malignancy encountered at King Faisal Specialist Hospital and Research Centre (KFSH&RC). Of 19,885 different malignant tumors seen during the period fro 1975 to 1989, there were 875 cases (4.4%) of TC. Of 1374 tumors of endocrine glands seen during the same period, 67% were thyroid neoplasms. TC represented 7.5% (618 cases) of all neoplasms in the females, second only to breast cancer. All types of TC were seen, with papillary thyroid carcinoma (PC) being the most common (79%). Anaplastic, medullary, follicular (FC), malignant lymphoma and Hürthle cell cancer accounted for 5.4%, 5.3%, 4.3%, 3.6% and 0.9% respectively. The frequency of PC was very similar (16%) in each of the third, fourth and fifth decades. The relative frequency (RF) of different types of TC was highest for PC with a ration of 18:1 between PC and FC, which could be the highest ever reported. There was a clearly progressive increase in the number of thyroid tumors referred between 1975 and 1989. Although this increase was evident for both sexes, it was more apparent for females. There was also a distinct increase (P<0.01) in the RF of PC from 76% (1975 to 1980) to 85% (1986 to 1989) with a decrease in FC from 9% to 2.5% over the same periods.