Study on socio-demographic characteristics and diagnosis profile of patients attending psychiatry out patient department,cmc,nepal

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

1. 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

3. 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.
4. Smith AL,Weissman,M.M,Smith. Cross national epidemiology of major depression and bipolar disorder. Journal of American medical association. 1992;
5. 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