A study on referral of patients in Department of Psychiatry at Lumbini Medical College and Teaching Hospital

Introduction: In a developing country like Nepal, where there is inadequate awareness but more social stigma towards psychiatric illnesses among people, there is an important role of referral psychiatry. Referral psychiatry has been considered to be an interface between psychiatric and non-psychiatric medicines as practiced in general hospital settings. This study analyses the psychiatric problems among patient referred to psychiatry department from other outpatient departments and emergency department in a tertiary care centre. Methods: This was a descriptive hospital-based study conducted among patients who were referred to psychiatry department from different outpatient departments of Lumbini Medical College and Teaching Hospital from November 1, 2019 to April 30, 2020. Ethical issues were considered strictly. Data were entered into Statistical Package for the Social Sciences version 21.0 and descriptive analysis was done. Results: A total of 781 patients were referred out of which more than half (n=487, 62.35%) were females and the most common age group was 41 to 50 years (n=175, 22.4%). Majority of patients (n=284, 36.4%) were referred from medicine department. The most common psychiatric illness diagnosed were those included under International Classification of Diseases 10th Revision F40-48 (Anxiety, Dissociative, Stress-related, Somatoform and other Non-Psychotic Mental Disorders). Conclusions: Referral psychiatry plays an important role to diagnose the undiagnosed psychiatric illnesses earlier and better and manage accordingly so it should be prioritized and practiced in health centers.

Assessment of psychiatric comorbidities and sociodemographic profiles of the patients referred to the general hospital psychiatric unit of a tertiary care hospital in Kolkata, West Bengal

Background: According to the previous studies, psychiatric symptoms are high in patients with physical illness, but the referral rates are much below expectation. Aims and Objectives: Here a descriptive cross-sectional study has been conducted using self designed semi structured proforma to asses the socio demographic profile and psychiatric diagnosis of patient with physical illness referred from other departments in a tertiary medical care centre for consultation liaison (C-L) psychiatry care. Materials and Methods: The study population consists of the patients referred to psychiatry department for consultation purpose from all the other departments in a 4 months period. The data were collected on a self designed semi structured pro forma and all the diagnosis were made according to International Classification of Disease -10 (ICD-10) criteria. Analysis has been done using descriptive statistics. Results: A total numbers of 203 patient has been referred to psychiatry department during the study period . Among them 144 were inpatient and 59 were outdoor based referral. Majority were female, married . The maximum referral were from general medicine department followed by neuromedicine. Most common reason of referral being suicidal attempt by different means followed by patients having depressive features .The most common psychiatric diagnosis was depression followed by delirium. Conclusion: C-L psychiatry plays a significant role in better evaluation and management of patients with psychiatric comorbidities referred from non-psychiatric departments.

Predictability of Discrimination Coefficient and Difficulty Index of Psychiatry Multiple-Choice Questions

Background: Multiple-choice questions are among the most common written tests. This study aimed to evaluate the faculty members’ability to determine and predict the level of difficulty and discrimination coefficient of multiple-choice tests at Psychiatry Department. Methods: All faculty members at Psychiatry Department of Iran University of Medical Sciences participated in this study. The difficulty and discrimination coefficient of all questions (150 questions) of the mid-term exam of psychiatric residents were measured with both software program and formulas by hand. Then, from each group of questions with high, medium, and low difficulty coefficient, 10 questions (30 questions in total) were selected and provided to faculty members for ranking each question in terms of difficulty and discrimination coefficient. Finally, the correlation between faculty members’ evaluation and standard results was measured by the Spearman’s correlation. To calculate the discrimination coefficient, the number of people who answered a question correctly in the low-score group was subtracted from the high-score group and then the result was divided by the number of people in a group. Results: Twenty-five faculty members participated in this study. There was a significant negative correlation between difficulty level and discrimination coefficient in the whole group (r=-0.196, p=0.045), but this was not the case in the upper and lower groups (r=-0.063, p=0.733). In addition, the correlation between the discrimination coefficient obtained from the formula and the average discrimination coefficient of faculty members was not significant (r=-0.047, p=0.803). Conclusion: It seems that the ability of faculty members to predict the discrimination coefficient and difficulty level of questions is not sufficient.

A STUDY OF PROFILE OF PATIENTS REFERRED TO PSYCHIATRY DEPARTMENT FROM OTHERS DEPARTMENTS

Introduction: The aim is to study the Profile of patients referred to Psychiatry department in a Medical College & Hospital in Rajasthan. Material and Methods: A study of 100 subsequent patients was conducted in psychiatry department, Diagnosis was made by psychiatrists based on ICD-10 guidelines. Data was analyzed using appropriate statistical techniques. Results: 18.00% of patients were diagnosed as Mixed anxiety & depression followed by depressive disorder 23.00%. Somatoform disorder and acute stress reaction adds 5% each. 3.00% diagnosed as psychosexual disorder followed by nil psychiatric diagnosis 2%, schizophrenia and organic psychosis/delirium 1% each. Conclusion: Psychiatric co-morbidity may present in acute & chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric co-morbidity. The General medicine was the main department for referring patients. Keywords: Psychiatry references from medical& surgical departments, Consultation Liaison Psychiatry.

PSYCHIATRIC DISORDERS IN CHILDREN: PATTERN AND CORRELATES AMONG THOSE REPORTING TO A TERTIARY CARE HOSPITAL

Objective: To determine the pattern of psychiatric disorders among children reporting to the Psychiatry department Pakistan Naval Ship Shifa Hospital, Karachi. Study Design: Comparative cross sectional study. Place and Duration of Study: Psychiatry department Pakistan Naval Ship Shifa Hospital, Karachi, from Feb to Aug 2018. Methodolgy: A total of 100 children, aged between 6-12 years of age, both male and female, meeting the selection criteria of the study, presenting to the Psychiatry department at Pakistan Naval Ship Shifa Hospital, were enrolled for this study. Informed consent was taken from the parents. The consultant psychiatrist interviewed the patients and diagnosed any psychiatric disorders based on international classification of diseases version 10. The data was recorded on the study proforma. Results: Out of a total of 100 children, 66 (66%) were male, while 34 (34%) were female. The mean age of the participating children was 8.66 + 1.97 years. The most common psychiatric disorder was attention deficit hyperactivity disorder 44 (44%), followed by depression 30 (30%). Other diagnoses included oppositional defiant disorder 12 (12%), conduct disorder 9 (9%) and separation anxiety disorder 5 (5%). Conclusion: Attention deficit hyperactivity disorder and depression are amongst the quite prevalent psychiatric disorders, than that was considered earlier.