Pattern, clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital: a descriptive study

Abstract

BackgroundConsultation liaison psychiatry (CLP) as a subspecialty is defined as the area of clinical psychiatry that encompasses clinical understanding, teaching and research activities of psychiatrists and allied health professionals in the non-psychiatric divisions of a general hospital. Psychiatric comorbidity of inpatients in tertiary care hospitals is huge. However, the amount of research in India in the field of consultation liaison is strikingly low.AimTo investigate the sociodemographic profile and psychiatric and physical subtypes of illness in patients admitted in other departments and referred to psychiatry department.MethodsThe study population comprised all consecutive inpatients referred for psychiatric consultation from other departments of a multispecialty tertiary care teaching hospital over 3 months. In a semistructured proforma, sociodemographic profile, referring departments, reasons for referral, referral rate, psychiatric diagnosis and physical illness diagnosis were recorded and analysed using descriptive statistics.Results172 patients were included and assessed after referral from various departments, of which 56.4% were male and 43.6% were female. The mean age was about 33.95 years, with majority of the patients in the 21–30 years age group. The referral rate was 1.1%. The maximum referrals were from the medicine department, with abnormal behaviour (26.2%) being the most common reason for referral, followed by alleged suicide attempt or self-harm (24.4%), anxiety (10.5%), substance use (10%) and disorientation (7.6%). The most common psychiatric disorder among patients was depressive disorder (24.4%), followed by substance use disorder (19.7%), schizophrenia and psychotic disorder (9.3%), and stress and trauma-related disorder (8.1%).ConclusionThere are very few psychiatry referrals and an alarmingly low referral rate, given the psychiatric morbidities in the medical setting. Psychiatry training should have more weightage across different medical specialties and liaison activities between psychiatry and other disciplines should be augmented, which can lead to a better understanding of psychiatric symptomatology, early symptom recognition, swift referral and ensuring follow-up, which, in turn, would be key to improving CLP services.

Profile of Patients Seen in Consultation-Liaison Psychiatry in India: A Systematic Review

“…Out of the 33 studies describing the patient profile, more than half ( n = 20) were published in the last 5 years. Most of these studies reported the patient profile of inpatients ( n = 14), 4 – 17 with a few reporting the profile of the patients referred to the psychiatry outpatient department from other specialties, 11 and others reported patients seen by the CLP team in the emergency setting. 17 – 22 Occasional studies have reported profiles of both inpatient and outpatient referrals.…”

“…Furthermore, some older studies reported the diagnosis as per the International Classification of Diseases (ICD), 9th revision (ICD-9), 4 , 8 , 19 , 27 whereas recent studies used the ICD-10 criteria. 5 – 7 , 9 , 11 , 14 , 15 , 17 , 18 , 20 – 23 , 25 , 26 , 28 – 33 Occasional study reported the diagnosis as per the Diagnostic and Statistical Manual (DSM) criteria. 36 A few studies have been silent about the criteria used to make the diagnosis.…”

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

“…The mean age group of referral is 36.33 years, with 22 (10.83%) of patients has age ranging from 60 years and above which is bit on higher side than a previous study conducted in India and rest 181 (89.1%) of them has age below 60 years, similar results found in other studies as well. 2,8 Majority of them were female (53.2%), while some other studies conducted before, shows a male predominance. 8,13 Most of the patients were from urban (38%), joint family (85%), married (67%), homemaker (33.99%), and studied till high school (36.4%).…”

“…2,8 Majority of them were female (53.2%), while some other studies conducted before, shows a male predominance. 8,13 Most of the patients were from urban (38%), joint family (85%), married (67%), homemaker (33.99%), and studied till high school (36.4%).…”

“…The co-occurence of general medical disorder and psychiatric illness is one of the most common and disabling combinations, with approximately 30% of individuals with comorbidities are having both of physical and psychiatric disorders. 8 According to Levenson et al, patients with associated psychopathology had longer duration of hospital stay, more chance to undergo interventional procedures, overburdening the health-care resources, and poorer prognosis. 9 A timely psychiatric intervention in these cases can improve the outcome including mortality and morbidity.…”