Common but unexplored psychiatric morbidity among referred indoor patients: A Liaison study in India

Abstract

The background of this investigation is the global occurrences of the large number of unexplored cases of psychiatric morbidity among referred indoor patients from non-psychiatric clinical domain. Present Consultation-Liaison (C-L) study explore the prevalence of disorders in mental-health and its relation to different psychosocial and demographic factors among referred patients from general medicine, chest medicine and cardiology departments of a Medical College, India. Here, 102 patients (13–75 years) were assessed and diagnosed by clinical interview utilizing Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, Glasgow Coma Scale, Mini Mental State Examination. After initial assessment of inconsistent behaviors, depression, delirium in referring ward, patients were evaluated in the psychiatric outpatient department by Thematic Apperception Test, Rorschach Ink Blot Test and Raven's Standard Progressive Matrices. The SPSS for Windows statistical software package (SPSS) was used for descriptive statistics. Group comparison and their interrelations were drawn by percentage calculations and Chi-square analysis. The present finding reveals that both sexes are equally affected whereas, age-wise, 16–45 years of either gender and >55 years of male are affected more. The 75% patients of total referrals are urban dwellers. The patients in <16 years group of rural and >55 years of urban are affected more. Marital statuses manifest differential prevalence of this disorder in the participants. The male has higher cognitive whereas the female has a higher mood disorder. Materialistic life, psychosocial maladjustment, inadequate benefits and diagnostic uncertainty strongly correlate with the present findings and highlight the occurrence of psychiatric cases from the non-psychiatric clinical domain.

Introduction

The Consultation-Liaison (C-L) psychiatry has been reported and studied in Europe, South East Asia and several other parts of the world.1, 2, 3, 4 Studies in this field are aimed to assess and manages the acute or emergency presentation of psychiatric morbidity including depression and suicidal incidence in the general medical settings.5, 6, 7 A growing body of evidences indicates that there is an association between physical illness and psychiatric disorder.5, 8, 9 Several reports reveal that Consultation-Liaison psychiatry has also been practiced in several parts of the world especially in the western world.10, 11, 12 The demographic and clinical characteristics of referrals to Liaison psychiatry have been studied in different countries and diagnostic services have been provided accordingly.¹³ In a consultation practice in general hospital settings; the psychiatrist offers recommendations to patients who are referred to him by other physicians, surgeons, and gynecologists. Reports reveal that the prevalence of mental-illness in chronically physically-ill patient is more than 40 percent, particularly with the criterion of lifetime substance abuse, depression and mood/anxiety related disorders.¹⁴ The importance of the present study has been shown in several investigations in India and other countries.8, 9, 15 In spite of a higher prevalence of C-L Psychiatric morbidities in India, the overall referral rate is only 1.48%.¹⁶

In this background, the present study is undertaken to assess the incidence of mental disorder of psychiatric referrals from general medicine, chest medicine and cardiology departments. In addition, correlations have been drawn between rural and urban incidence taking into account the other possible socio-demographic determinants. Our study is absolutely important to address the high occurrence of psychiatric symptoms from non-psychiatric domain. Furthermore, a brief discussion and critical analysis have been made on several psycho-social risk factors which can influence the psychological makeup of individuals, large group of the masses and as a whole total community.