A Cross-Sectional Descriptive Study of Prevalence and Nature of Psychiatric Referrals from Intensive Care Units in a Multispecialty Hospital

Article excerpt

Byline: Govind. Bhogale, Raghavendra. Nayak, Mary. Dsouza, Sameeran. Chate, Meenakshi. Banahatti

Context: The prevalence of psychiatric comorbidity in general hospital range from 20% to 60%. Presence of psychiatric morbidity compounds the disability and suffering in medical patients. There is a limited literature on the prevalence of psychiatric morbidity in patients admitted in the intensive care units (ICUs). Aims: The aim of the study was to estimate the prevalence and nature of comorbid psychiatric illness in the cases referred from ICUs. Settings and Design: Cross-sectional observational study. Materials and Methods: This study included all the consecutive patients referred from different ICUs to psychiatry department for consultation during the four-year period from January 1, 2000 to December 31, 2003, assessment was done by psychiatrist and diagnosis was made using ICD-10. Statistical Analysis: Descriptive statistics. Results: There were 309 (1.97%) referrals from ICUs to psychiatry department during the period of study. Among the referred patients, diagnosis of organic mental disorders was the commonest psychiatric diagnosis present in 104 (33.65%) patients followed by suicidal attempt in 101 (32.69%); anxiety disorders in 40 (12.94%); depressive disorders in 21 (6.8%); Psychotic illness in 10 (3.24%); other psychiatric illnesses in 28 (9.06%); and nil psychiatric illness in 5 (1.62%) patients. Conclusion: Prevalence of psychiatric referrals from ICUs was low. This could be due to stigma and lack of awareness among physicians. There is increased need for recognition and treatment of comorbid psychiatric illness by the treating physicians which may help to decrease morbidity and overall cost of the treatment.


General hospital psychiatry is a broad term that implies the existence of psychiatric service as one of the many specialty services available in a general hospital. This psychiatric service may exist in one or more of the several forms, viz. out-patient, indoor, and referral (including one or both of the two components - consultation and liaison). The psychiatric wing of such a hospital is called the GHPU (General Hospital Psychiatric Unit). [sup][1] In January 1958, N.N. Wig started the first GHPU at Medical College, Lucknow, with both in-patient and out-patient psychiatric services and a teaching program as a part of the Department of Medicine. Dr. J.S. Neki started a similar unit at Medical College, Amritsar, a few months later. [sup][1] The spectrum of psychiatric cases seen in general hospital psychiatry units is much wider than seen in mental hospitals. In specified mental hospitals, the clinical material is predominantly psychosis, i.e., major mental disorders. However, in a general hospital psychiatry unit, there is a wide range of clinical problems including psychosis, neurosis, personality disorders, drug dependence, organic brain disorders, etc. [sup][2],[3],[4] The overall prevalence of psychiatric comorbidity in general hospital range from 20% to 60% depending on the different methodologies used in those studies. [sup][5],[6] Presence of psychiatric morbidity compounds the disability and suffering in medical patients. Furthermore, it increases the consumptionof medical resources, [sup][7] complicates medical treatment, [sup][8] and can result in poorer outcome. [sup][9] Most research on the psychiatric morbidity in the general hospital is related to general medical patients with specific physical disorders. [sup][10],[11] Before 1990s, metro cities in India had hardly any multispecialty hospitals. In the last two decades, multispecialty hospitals started functioning in small cities and very big towns of India. In the last decade, very few teaching hospitals had attached multispecialty hospitals with intensive medical care units. KLEs Dr. Prabhakar Kore Hospital and Medical Research center is one such hospital which is a teaching hospital of J N Medical College Belgaum. …


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