A retrospective chart review of clinical characteristics and magnetic resonance imaging findings of patients from a psychiatric facility in KwaZulu-Natal province, South Africa

Abstract

BackgroundMany neurological conditions manifest with psychiatric symptoms and may be misdiagnosed. Structural neuroimaging, that is, computerised tomography (CT) and magnetic resonance imaging (MRI), can aid in the diagnosis or exclusion of these conditions. Magnetic resonance imaging is preferable in this regard, but is more expensive and less readily available than CT. The indications for requesting MRI in the clinical psychiatric setting remain poorly defined. All published literature on the clinical utility of neuroimaging in Africa is on CT scans.AimThe aim of this study was to describe the clinical characteristics and MRI findings in a cohort of patients presenting with psychiatric symptoms.SettingA specialist psychiatric training hospital, Townhill Hospital, in Pietermaritzburg, KwaZulu-Natal.MethodsA retrospective chart review of all patients who underwent MRI between 01 October 2010 and 31 June 2016 was done. Magnetic resonance imaging findings were correlated with socio-demographic and clinical information, including psychiatric diagnosis, indication for MRI imaging and effect on clinical management.ResultsFifty-three MRIs were performed. Thirty-three (62%) were abnormal. Patients with HIV, neurocognitive disorders, chronic mental illness and involuntary admission were more likely to have abnormal scans (83%, p = 0.089; 80%, p = 0.496; 71%, p = 0.089 and 79%, p = 0.021, respectively). The findings of 54% of abnormal MRIs (24% of all MRIs performed) resulted in referral to other disciplines. No statistically significant associations were found with socio-demographic or clinical factors.ConclusionAbnormalities on MRI scans in mentally ill patients were common and a quarter of patients required referral to other disciplines. Further studies are required to clarify the clinical utility of MRI in patients with psychiatric illness, which could assist in the development of a guide for the rational use of this modality in a resource-constrained environment.

Clinical use of neuro-imaging in psychiatric patients at the Charlotte Maxeke Johannesburg Academic Hospital

“…As this study was a retrospective record review, it is possible that not every patient was subject to an HIV test, thus accounting for the low yield of abnormal scans. In a recent article, Juby et al 24 also observed that the HIV status in 22.6% of their patients was unknown. They attributed this to the problems associated with obtaining informed consent for HIV testing from some mental healthcare users.…”

“…However, some studies have reported a much higher yield. A recent study by Juby et al 24 at Townhill Hospital in Pietermaritzburg, KwaZulu-Natal, retrospectively reviewed the charts of all psychiatric patients who had neuro-imaging between 2010 and 2016 and found that of the 53 MRIs performed, 62% were abnormal. Gupta et al 25 studied 102 consecutive patients referred for CT brain scanning for primary psychiatric diagnosis in 2003 in the Department of Radiology at West Wales Hospital, Carmarthen.…”

“…The authors further reported that subcortical white matter changes and cerebral atrophy were the common pathologies. Juby and Paruk 24 reported that 83% of the HIV-infected subjects had abnormal MRIs.…”

“…They attributed this to the problems associated with obtaining informed consent for HIV testing from some mental healthcare users. 24 Joska et al 57 for the use of ‘clinician-initiated testing’ proposed by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) recommended that in mental health care users who do not have the capacity to make this decision, a senior clinician and/or the medical superintendent should be consulted to weigh up the potential harms and benefits of HIV testing and approve testing. 57…”