Author: Michael Elnemais Fawzy

Mental health services in Egypt are mainly provided by hospitals with insufficient attention given to integrating mental health into primary care. The majority of the available resources are allocated to a few large centralized psychiatric hospitals. The Institute of Medicine (2001) defines quality clinical care as care that is equitable, timely, safe, efficient, effective and patient-centered. This article describes a three-pronged strategic approach for enhancing mental health services through policies designed to improve quality and equity.

''Abstract''

''Background''

Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression.

''Methods''

Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale score ≤10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session.

''Results''

In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46 …

Among individuals hospitalised with depression, we found no evidence for a clinically significant increased risk for serious medical events with exposure to electroconvulsive therapy, and the risk of suicide was found to be significantly reduced, suggesting the benefits of electroconvulsive therapy for depression outcomes might outweigh its risks in this population.

500 milliamps may be as effective as 900 and cause fewer cognitive side-effects.

أثار قانون 2009 جدالاً منذ بداية الحديث عنه في عام 2008 بسبب انقسام العاملين في مجال الطب النفسي لتيارين. التيار الأول شارك في صياغة القانون وأيده، ويرفض أي تعديلات تنتقص من حقوق المرضى أو تعمل على تغيير المصطلحات واقتطاع المزيد من الميزانية المحددة لقطاع المرض النفسي. الثاني يرفض القانون ويسعى منذ سنوات ومن خلال قنوات مختلفة لإقرار تعديلات تسلب المريض النفسي حرية تقرير مصيره وتزيد من سلطة الطبيب النفسي وسطوته.

"This letter is a plea to psychiatrists worldwide to follow us in changing the name of ECT to BST, in order to decrease the stigma associated to this therapy and to allow more patients receiving a treatment that has become unpopular also because of its name, but that, if applied in the correct manner, can be life saving."

Ruling against emergency involuntary ect without oversight

"as a psychiatrist, if I ever had the misfortune to develop severe depression, my treatment of choice would be electroconvulsive therapy (ECT)."

http://bit.ly/iOZlgo -- وقف العمل بجهاز علاج الصدمات الكهربائية يكشف الحاجة لتفعيل دور المجالس الرقابية في حماية المرضى النفسيين

Negar Azimi's article about gay rights in Egypt. Interviews Psychiatrists; some receive ECT.