Table Of ContentPSYCHIATRIC REFERRAL IN THE AL-QASSIM REGION, SAUDI ARABIA:
THE ROLE OF GENERAL PRACTITIONERS
Naseem Akhtar Qureshi
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PSYCHIATRIC REFERRAL IN THE AL-QASSIM REGION, SAUDI ARABIA:
THE ROLE OF GENERAL PRACTITIONERS
PSYCHIATRISCHE VERWIJZINGEN IN DE AL-QUASSIM REGIO IN SAOUDI-
ARABIË: DE ROL VAN HUISARTSEN
PROEFSCHRIFT
ter verkrijging van de graad van doctor aan de
Erasmus Universiteit Rotterdam op gezag van de rector magnificus
Prof.dr. S. W. J. Lamberts
en volgens besluit van het college voor promoties.
De openbare verdediging zal plaatsvinden op
donderdag 10 maart 2005 om 13:30 uur
door
Naseem Akhtar Qureshi
Geboren te Uttar Pradesh, India
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Promotiecommissie
Promotoren
Prof.dr. H.T. van der Molen
Prof.dr. H.G. Schmidt
Overige leden
Prof.dr. P.E.H.M. Muris
Prof.dr. J. Passchier
Prof.dr. F.C. Verhulst
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Dedicated to my late parents- Ladley Begum and Abdul Jabbar who devoted
everything to educate and uplift the life of their six children: Mr.Viqar Ali Qureshi, Mr.
Mohd Ambar Qureshi, Prof. Saleem Akhtar, Dr. Naseem Akhtar Qureshi, Mrs. Razia
Jabbar Abid and Mrs. Tauseef Jabbar Qasim.
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CONTENTS
Chapter 1 General introduction
Chapter 2 Review of literature
Chapter 3 An analysis of psychiatric referrals, Saudi Arabia
Chapter 4 Psychiatric referrals: in primary care and general hospitals
in Al-Qassim Region, Saudi Arabia
Chapter 5 Psychiatric co-morbidity in primary care and hospital
referrals, Saudi Arabia
Chapter 6 Psychotropic drug prescriptions in primary care and general
hospitals, in Saudi Arabia
Chapter 7 Quality of psychiatric referrals: structural equation modeling
approach
Chapter 8 Integration of mental health into primary care in Al-Qassim
Region, Saudi Arabia: planning phase I
Chapter 9 Integration of mental health into primary care in Al-Qassim
Region, Saudi Arabia: curriculum development II
Chapter 10 Effectiveness of a training programme for general
practitioners directed at the enhancement of psychiatric
knowledge and change of unfavorable attitudes against
psychiatry
Chapter 11 General discussion
Summary
Summary in Arabic language
Acknowledgements
Curriculum vitae
Author’s other publications
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CHAPTER 1
GENERAL INTRODUCTION
The firm roots of this thesis are deeply grounded in an unexplored, nearly virgin
area that is yet to be investigated extensively for realizing its full mental health care
[MHC] potential. This area is the referral system and the psychiatric training programs
for GPs in the Kingdom of Saudi Arabia [KSA]. The literature on both referral system
and psychiatric training programs for GPs in the KSA is scanty. Despite the fact that most
of psychiatric health consumers are primary health care [PHC] clients, most of the health
related developments for training and improving the skills of physicians for identifying
and appropriately treating psychiatric disorders have taken place at secondary and tertiary
health delivery levels. Hence, one is likely to ask the question “do psychiatrically
untrained GPs provide adequate psychiatric help to PHC patients with simple to complex
psychiatric disorders?” Obviously, the answer is no and the paradox is that psychosocial
problems and psychiatric disorders at PHC level are hidden but probably of great
magnitude. Therefore, their precise incidence, etiologies, diversities and resulting harm
and burden endured by the patients, families and healthcare delivery systems are not fully
explored in Saudi Arabia as a whole, and Al-Qassim area in particular. Many mental
patients with complex disorders need psychiatric consultation and hence psychiatric
referrals. Evidently, many burning issues related to the concealed or secret psychiatric
health problems are worse in rapidly developing countries as compared to the developed
world.
1.1. Main Aims of this thesis
Two related central issues that this thesis addresses are (1) psychiatric referral
system and (2) psychiatrically untrained GPs who are rarely identifying and hence very
seldom referring mental patients for psychiatric consultation. Almost all GPs in the KSA
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lack psychiatric skills, have unfavorable attitudes toward psychiatry and are also
unskilled in referring psychiatric patients to secondary and tertiary care. Evidently, all
Arabian Gulf countries including the KSA are facing a real health challenge in terms of
primary care psychiatry, which is globally recognized as an important burgeoning field of
psychiatry. These facts stimulated the author to take this project that aimed to integrate
MHC into PHC through training of GPs and paramedical staff in clinical psychiatry and
psychiatric referrals. There were hardly any psychiatric training programs for GPs about
a decade ago. Accordingly, it was decided that the whole issue needs urgent attention and
comprehensive research to address it in sufficient depth. Notably, our team is the first to
conduct extensive research on psychiatric referrals and attitudes in the Arab world and
also to train GPs in psychiatry in Al-Qassim area. Thus, there are two main aims of this
thesis. The first aim is to undertake a number of investigations into the quality of the
referral system in the KSA. The second aim is to try to improve the knowledge of clinical
psychiatry and attitude against psychiatric patients of GPs.
1.2. Chapters of this thesis
After a comprehensive review of the literature (chapter 2), we explored different
aspects of referral system and also the psychiatric training programs directed towards
general practitioners for enhancing their psychiatric skills and changing their negative
attitudes against psychiatry. This thesis consists of eight articles that have been published
in various scientific journals and some of them were also presented as papers at national
or international conferences. The first five chapters (i.e., chapters 3,4,5,6,7) examine
comparatively various aspects of psychiatric referral letters that were originated from
primary health care centers [PHCCs] and general hospitals [GHs]. Though the subject of
these five chapters is the same, the objective of each paper is quite different. Chapter 3
deals in detail with the adequacy/inadequacy of noted data in both types [PHCCs versus
GHs] of psychiatric referral letters. Chapter 4 examines the psychiatric symptomatology
noted by physicians in both types of referrals. Chapter 5 describes psychiatric co-
morbidity in PHC and GHs referrals. Chapter 6 highlights mental health specialists
prescribing patterns of psychotropic drugs to these successfully referred patients as
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Description:Saleem Akhtar, Dr. Naseem Akhtar Qureshi, Mrs. Razia Chapter 6 Psychotropic drug prescriptions in primary care and general hospitals, in Saudi
