Introduction: Psychiatric
problems at general hospital are increasing. People with mental illnesses
prefer general hospital over mental hospital seeking for the treatment. The
objective of this study was to demonstrate the socio-demographic &
diagnostic profile of patients attending outpatient department (OPD) of a
general hospital.
Method: This is a retrospective study on the data
recorded in the psychiatric department of Chitwan School of Medical Sciences.
Demographic data and disease profile of 4474 patients attending the OPD were
analyzed. The ratios and proportions were used for statistical analysis.
Result: The male to female ratio
was almost the same (0.51:0.48). Farmers
(54.66%) were the most common visitor. The age group 41-50 (27.89%)
followed by age group 11-20 (22.19%) was the commonest. The
depressive disorder (46.96%) and somatoform disorder (10.75%) were the two
commonest diseases diagnosed.
Conclusion: Most of the patient of younger age group attend
psychiatric OPD of Chitwan Medical College, Bharatpur.The commonest incidence
of psychiatric illness attending the hospital are depressive and somatoform disorders.
Key words: diagnosis profile, socio-demographic characteristics
INTRODUCTION
Nowadays,
Patients with psychiatric problems attending the general hospital are
increasing. The hospital data of different researches show that people prefer
to visit general hospital for treatment of mental disorder rather than mental
hospitals. World health organization recommends that it is better to establish
psychiatric units in general hospitals. Because of the requirement of many
consultants liaision working with each other to come to a diagnosis shows that
treatment in general hospital is better than mental hospital because of
unavailability of the other specialty.
So
it has been found that psychiatric disorders treated in general hospitals get
good care as compared to mental hospitals. This article shows the
socio-demographic & disease profile of patients attending outpatient
department (OPD) of a general hospital.
Correspondence:
Dr. C.P. Sedain, Associate
professor,
Deparment of Psyciatric,CSMS
Email: drcpsedai@yahoo.com
MATERIAL AND METHOD
|
Table-2:Distribution of
Proportion of level of education
|
||
|
Education level
|
Frequency
|
%
|
|
Illiterate
|
771
|
17.23%
|
|
Primary
|
605
|
13.52%
|
|
Middle
|
876
|
19.58%
|
|
SLC
|
960
|
21.46%
|
|
Intermediate(SLC+1)
|
894
|
19.98 %
|
|
graduate
|
368
|
8.23%
|
|
total
|
4474
|
100%
|
This
is retrospective study based on the data recorded in the psychiatric department
of Chitwan School of Medical Sciences. Data profile of all patients attending
in psychiatric OPD were included for the
study. The time period covered was from October1, 2008 to September 30, 2009.
Demographic data and diseases profile of 4474 patients attending the OPD were
analyzed. The ratios and proportions were used for statistical analysis. The
rapport was established with the patients to obtain enough information. The
semi structured Proforma was filled with adequate information The Proforma
composed of name, age, sex, marital status, education and ccupation. Questions
related with complaints of the patient was taken which include chief
complaints, history of present illness, past history, family history and
premorbid personality. The examination of the patient was done in a detailed
manner, which includes general examination, systemic examination and mental
state examination. ICD-10DCR diseases diagnosis code was strictly followed 1.
RESULTS
Out of 4474 patients, 51.63
%( 2310) were male and 48.63 %( 2164) were female. Male to female ratio was
1.06:1 showing slightly male predominance. Patients of age group 41-50 showing
the largest proportion (27.89%) followed by 11-20 years (22.19%) (Table-1).
|
Table -1:Percentage distribution Age group and
Sex
|
||||
|
Age group
|
Male
|
Female
|
Total
|
%
|
|
0-10
|
48
|
42
|
90
|
2.01
|
|
11-20
|
510
|
483
|
993
|
22.19
|
|
21-30
|
393
|
421
|
814
|
18.19
|
|
31-40
|
369
|
297
|
666
|
14.87
|
|
41-50
|
645
|
603
|
1248
|
27.89
|
|
51-60
|
270
|
267
|
537
|
12.03
|
|
61≥
|
75
|
51
|
126
|
2.82
|
|
Total
|
2310
|
2164
|
4474
|
100
|
Table -2 depicts the educational status of the
patient.The highest proportion of the cases were SLC level (21.46%) followed by
Intermediate level (19.98%).
|
Table-4:Disturibution
on the basis of icd-10 diagnosis code
|
|||
|
|
Diagnosis
|
case
|
|
|
ICD-10 code
|
|
no
|
%
|
|
F-32
|
Depressive disorder
|
2101
|
46.96
|
|
F-45
|
Somatoform disorder
|
481
|
10.75
|
|
F-30
|
Mania/ BPAD
|
455
|
10.17
|
|
F-41
|
Anxiety disorder
|
174
|
3.89
|
|
F-44
|
Conversion disorder
|
153
|
3.42
|
|
F-20
|
Schizophrenia
|
149
|
3.33
|
|
G-44
|
Tension/migrain headache
|
144
|
3.22
|
|
G-40
|
Epilepsy
|
208
|
4.65
|
|
F-23
|
Acute psychosis
|
114
|
2.55
|
|
F-10
|
Drug/alcohol use disorder
|
211
|
4.72
|
|
F-2
|
Dementia
|
51
|
1.14
|
|
F-70
|
Mental retardation
|
59
|
1.32
|
|
F-43
|
PTSD
|
27
|
0.60
|
|
F-52
|
Psycho sexual disorder
|
21
|
o.47
|
|
F-93
|
Childhood depression
|
33
|
0.74
|
|
|
Others
|
93
|
2.08
|
|
Total
|
4474
|
100
|
|
Table-3 shows the distribution of occupation. Most of
the cases were farmer (54.66 %) followed by housewife (21.14%) by occupation.
|
Table-3:Disturibution: occupation
|
||
|
occupation
|
case
|
|
|
|
no
|
%
|
|
Farmer
|
2409
|
54.66
|
|
House wife
|
946
|
21.14
|
|
Service holder
|
356
|
8.00
|
|
Business
|
268
|
5.99
|
|
Student
|
179
|
4.00
|
|
Unemployed
|
316
|
7.03
|
|
Total
|
4474
|
100%
|
The largest number of psychiatric disorder in OPD was
depressive disorder (46.96 %), followed by somatoform disorder
(10.75%)(Table-4) nevertheless epilepsy and alcohol use disorder were also
common.
DISCUSSION
The
life style is becoming complex day by day, thus the patients consulting the
department of psychiatry is increasing than previous decade. Depressive
disorder is the commonest psychiatric disorders worldwide. Other psychiatric
disorder like schizophrenia, BPAD, alcohol & drug addiction problems are
also equally challenging to us.
A
ten-year perspective study in Zurich, (Angst, 1992) estimated the life time
prevalence
of major depression is about 16 percent. The rates of depressive
disorder
seems to be higher in industrialized countries2. They are
consistently increased in woman across different cultures. Nepal et al Regmi et
al reported that patients attending to psychiatric OPD of TUTH were commonly
neurotic and harboaring stress related disorder2. Similarly Sharma’s
study shows 41℅ patients were depressive disorder only. Pokhrel
et
al reported that mood disorder (35℅) followed by schizophrenia and related
disorder (28℅) and neurotic and stress related disorder (17℅) respectively3. The percentage
distribution of depressive illness reported by Sharma is similar to our
finding.
Major
depression is the commonest psychiatric problem seen in primary care center.
Depression is more common among the unemployed and divorced people. If we look
at our finding the depressive illness was observed among the patient of SLC and
intermediate education level. All medical illnesses and their treatment can act
as non-specific stress factor which may lead to mood disorder in predisposed
subject. Prevalence of psychiatric disorders among general hospital population
is higher than in community.
Patients
with psychiatric disorder do present with symptoms of medical illnesses.
Psychiatric disorders can be the consequence or coexist with medical
illness. Many previous studies have
shown that psychiatric disorders such as depressive disorder, anxiety disorder,
drug abuse, organic mental disorders and somatoform disorder could be
encountered approximately in 20-80 percent of in-patients in any of the general
hospitals world wide. About 20% of our patient admitted in medical and
gynecology departments, specially female patient, have some psychiatric
problems in the form of mood disorder and somatoform disorder.
REFERENCES
- Regmi et al. Studies of sociodemographic characteristics and diagnostic profile in psychiatric outpatient of TUTH. Nepalese Journal of psychiatry 1999; 1: 26-33.
2.
World Health Organization. International
Classification of disease and related heath problems, Tenth revision: Clinical description and diagnostic
guideline; Geneva: World Health Organization. 1992
- Pokhrel et al. Sociodemographic characteristics and diagnostic profile of patients admitted in psychiatric ward of TUTH, Katmandu. Nepalese Journal of psychiatry 1992;(2):13-17.
- Smith AL,Weissman,M.M,Smith. Cross national epidemiology of major depression and bipolar disorder. Journal of American medical association. 1992;
- Angst. J. How recurrent and predictable is depressive illness. In long term treatment of depression, eds S. Montgomery and F Rouillon.Wiley, Chichester; 1992:1-3
Hi, there. I am Tom Neil and I want to describe how life had been for my younger brother living with schizophrenia and how he had been permanently able to overcome this debilitating disease via a naturopathic, herbal method.
ReplyDeleteMaicon - my kid brother was twenty years old when he was brought to the emergency room by the campus police of the college from which he had been suspended several months ago. A professor had called and reported that he had walked into his classroom, accused him of seizing his tuition money, and refused to leave.
Although he had much academic fame as a teenager, his manner had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. My sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from my room and ask my family to be quiet even when they were not making any noise.
My father and sister told the staff that Maicon's great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Our mother left the family when Maicon was very young. She has been out of touch with us, and they thought she might have been treated for mental health problems.
Maicon agreed to sign himself into the psychiatric unit for treatment. The whole family except I had agreed to have Maicon transferred to a mental asylum. I knew inwardly there was still some plausible means by which my kid brother could overcome this condition. I knew botanical means of treatment will be more favorable than any other type of treatment, and as such, I had taken a keen interest in the research of naturopathic alternative measures suitable for the treatment of schizophrenia. I had pleaded for some little patience from the family in the delay of the transfer, I was looking forward to proving a point to the entire family, of a positive botanical remedy for this condition.
It was during my ceaseless search on the internet I had been fortunate enough to come across Dr. Utu Herbal Cure: an African herbalist and witch doctor whose professional works had majored on the eradication of certain viral conditions, especially schizophrenia, ( improving the memory capacity positively), via a traditional, naturopathic process and distinguished diet plan. It was by the administration of this herbal specialist that my brother had been able to improve his condition for better.
Before the naturopathic remedy - Maicon's story had reflected a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible.
My brother Maicon is just like many other patients out there suffering from this disease. Although he was able to overcome this condition via a naturopathic herbal remedy administered by this African herbal physician and saved completely thus, rekindling the lost joy which had been experienced by the family members.
I wish to use this opportunity to reach across to anyone who may happen to be diagnosed with this disastrous condition to spread the hope of an everlasting herbal remedy that is capable of imposing a permanent end to this disease.
For more information concerning this naturopathic herbal remedy, feel free to contact this African herbal practitioner via email:
drutuherbalcure@gmail.com