Fifty patients with a primary diagnosis of Obsessive-Compulsive Disorder (OCD) were studied during the course of the year 1994 from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to highlight the frequency with which the different forms and contents occur. Six types of obsessions were identified: doubts, thoughts, fear (phobia), images, impulses and miscellaneous. Compulsive acts were classified into two types: yielding and controlling. The contents of obsessions could be classified into eight broad categories as relating to: dirt and contamination, germs, aggression, sex, religion, blasphemy, illness and indecisiveness. Thirty eight percent of the patients displayed obsessional thoughts related to dirt and contamination, while forty per cent showed religious and blasphemous obsessional thoughts and doubts. Fifty six percent of the patients had compulsions of which 36% were multiple, while 20% displayed only a single compulsion. The paper discusses these findings and emphasizes the role played by sociocultural and religious factors in shaping the character of an obsessional thought content.

The aim of this study is to determine the antipsychotic prescribing pattern and the prevalence of concurrent anticholinergic prescribing in a psychiatric referral hospital. A retrospective audit of prescriptions issued for outpatients was carried out at the Psychiatric Hospital, the only facility that provides psychiatric services for both inpatients and outpatients in the Kingdom of Bahrain. Antipsychotic monotherapy was prescribed for 89.2% patients, whereas polytherapy with two-and three-drugs in 10.4% and 0.4%, respectively. Atypical antipsychotics were prescribed more often (67.7%) than typical antipsychotics. Risperidone and haloperidol were the most frequently prescribed antipsychotics. Long-acting risperidone injection was the only depot preparation prescribed. The mean antipsychotic dose expressed as chlorpromazine equivalent (CPZeq; mg/day) was 242 (220 for monotherapy and 414 for polytherapy). The prevalence of high dose antipsychotic (mean CPZeq > 1000 mg/day) was 1.8%, prescribed at a mean CPZeq dose of 1531 (1925 for monotherapy and 1137 for polytherapy), mainly attributed to haloperidol. Anticholinergics were co-prescribed for almost two third of patients receiving antipsychotics, particularly for those on polytherapy (monotherapy 57.3%; polytherapy 87.5%). Antipsychotic polytherapy, high dose and co-prescription of an oral with a depot antipsychotic preparation were strongly associated with concurrent prescription of anticholinergics. Procyclidine and orphenadrine were the most often prescribed anticholinergics. In Bahrain, antipsychotic monotherapy is a common practice for outpatients with psychotic disorders. Some of the antipsychotic polytherapies, dosage strategies, and high prevalence of anticholinergic use are therapeutic issues that need to be addressed to foster evidence-based prescribing practice.

A random sample of 100 new patients referred consecutively to the psychiatric hospital was assessed using the Arabic translation of the PSE. An abstract form was designed to include all PSE scores as well as the necessary extra data to make ICD-9, ICD-10, and DSM-III-R diagnoses. Kappa correlation was calculated for inter-rater and intra-rater reliability. Overall reliability and reliability of each major psychiatric diagnosis were compared between the three systems. The use of the PSE helped in achieving good agreement between Arab psychiatrists for all the three systems, but ICD-10 was found to have the highest reliability figures both for three-digit and four-digit psychiatric diagnoses.

The Kingdom of Bahrain is an archipelago of 33 islands, located in the Arabian Gulf, covering 2400 km2. The main island, Manama, is the nation's capital. The total population stands at 742 562, 62.3% of whom are local Bahrainis and the remaining 37.7% expatriates (Central Statistics Organisation Directorate, 1991). Bahrain first entered the historical stage around 3000 BC, and for almost 2000 years was the centre of the old Dilmun civilisation (Bibby, 1969). Dilmun was perceived as a sacred land by the Sumerians and Babylonians; it was a burial ground for their dead, and Bahrain has over 100 000 burial mounds each containing 200-250 bodies. In the old Babylonian epic of Gilgamesh, which antedates Homer's Iliad, Dilmun is described as a paradise where the worthy enjoy eternal life (Clarke, 1981).

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