___________________________________________________________
Psychiatry Outpatient Department, Jahurul Islam Medical College Hospital
Year of Study: 2010
_____________________________________________
Psychiatry Outpatient Department, Jahurul Islam Medical College Hospital
Year of Study: 2010
_____________________________________________
Asst.
Prof. S. Abdullah Al-Farooqa, Dr. Nitai Chandra Rayb
INTRODUCTION
Psychiatric
morbidity is one of the major health problems all over the world. Bangladesh is
a densely populated country, where prevalence of Psychiatric illness is similar
to other countries of the world. According to a report of World Health
Organization about 10% of the general population suffer from minor psychiatric
illness and 1% from major psychiatric disorders.1
Recently conducted national survey of mental health is Bangladesh showed that
16.05% of the adult population were suffering from psychiatric illness. The
prevalence of neurotic disorder, in the study was 8.4%, major depressive
disorder and psychosis were 4.6% and 1% respectively. The study also explored that
among the psychiatric patients 52.3% were detected suffering from neurosis,
28.7% major depressive disorder and 6.7% psychosis.2
Photo collected from: http://farm4.static.flickr.com |
Another rural
based study in Dasherkandi, a village nearby Dhaka found that 6.52% of the
population had been suffering from psychiatric illness.4
Among the
patients attending the outpatient department of National Institute of Mental
Health, Dhaka 37.46% were suffering from schizophrenia and other psychiatric
disorders, 16.14% anxiety disorder, 7.66% substance related disorders, 6.6%
somatoform disorders, 4.12% mental retardation and 7.88% other disorders.5
A study
carried out in private clinic in Dhaka city demonstrated that among their
admitted patients, 39.4% were suffering from schizophrenia and other psychotic
disorders, 18.75% mood disorders, 3.6% borderline personality disorder, 1.6%
somatoform disorders and 0.7% anxiety disorder.6
Jahurul Islam
Medical College Hospital is one of the few tertiary hospitals situated in the
rural area of Bangladesh. The aim of the study was to evaluate the pattern of
psychiatric diseases of the patients attending in the psychiatric outpatient
department of private medical college hospital situated in a village of the
Kishoregonj district of Bangladesh.
METHODS
The patients
consulted by the doctors at the psychiatry outpatient department of the Jahurul
Islam Medical College and Hospital (JIMCH) Bhagolpur, Bajitpur, Kishorgonj
during the period of January to December 2010 were included in the study.
Information regarding the patients were documented in the outpatient register
book. This was retrospective study. Data regarding specific diagnosis and the
patients’ socio-demographic criteria were collected from the register book of
the patients from the period of January to December 2010. Diagnosis of the
patients attending the psychiatry outpatient department done following the
Diagnostic and Statistical Manual for Mental Disorder 4th Edition
(DSM-IV) criteria of the mental disorder and confirmed with assistance of
consultant psychiatrist. Only new cases were included in the study. Data were
presented in the tabular form and statistical analyses were done as required.
The precaution was taken not to harm the physical and mental condition of the
patient and confidentiality of the personal data was strictly maintained.
RESULT
During the
period of January to December 2010, 1033 new cases were treated in the
psychiatry outpatient department of JIMCH, were included in the study. Out of
1033 cases 585 (56.63%) were male and 448 (43.37% were female from 4 years to
90 years age group. 668 (64.67%) patients were married , 339 (32.82%) were
unmarried, 21 (2.03%) were widow and only 5 (0.48%) were divorced/separated. 964
(93.22%) patients were Muslim and 69 (6.68%) were Hindus. A s the study were
carried out in the rural area, most of the patients 319 (30.88%) were
illiterate, followed by secondary education 281 (27.2%), primary education 199
(19.27%), passed secondary and higher secondary examination 181 (17.52%) and 53
(5.13%) patients were graduate. Most of the patients 929 (89.94%) resided in
the rural area and 104 (10.06%) were urban. Regarding occupational status among
the patients 387 (37.46%) were housewife, followed by students 167 (16.17%),
unemployed 139 (13.46%), businessman 99 (9.58%), 90 (8.71%) patients were
depend on agriculture. 317 (30.69%) patients from 18-27 years age groups had
more psychiatric disorder followed by 28-37 years age group 269 (26.04%) cases.
Out of 1033
patients 109 (16.36%) were suffering from generalized anxiety disorder in which
male suffer more than female. 164 (15.88%) were diagnosed suffering from major
depressive disorder in which female suffered more than male. Among the patients
85 (8.23%) diagnosed Bipolar Mood Disorder. 83 (8.03%) cases were schizophrenia, 87
(8.42%) brief psychotic disorder or schizophreniform psychosis, 24 (2.32%)
substance related disorder, men affected more than women. There were 24 (2.32%)
cases of conversion disorder and 44 (4.26%) somatoform disorders, most of them
were female. Regarding other disorders, 26 (2.52%) cases were obsessive
compulsive disorders, 7.16% suffered from other anxiety disorders, 56 (5.42%)
tension headache and migraine, 56 (5.42%) erectile dysfunction and premature
ejaculation, 20 (1.94%) epilepsy and 6 (0.58%) Dementia. There were 20 (1.94%) Attention-deficit
hyperactivity disorder, 6 (0.58%) mental retardation, 3 (0.29%) autistic
disorders. 203 (19.65%) cases were referred from other outpatient departments
of the hospital. 219 (21.20%) patients showed positive family history of
psychiatric illness, 235 (22.75%) were smokers and 47 (4.55%) used illicit
substances.
Table-1: Distribution of
Patients by Sex, Age Group, Habitat, Religion and Marital Status
Particulars
|
Number
|
Percentage
|
Sex
|
||
Male
|
585
|
56.63%
|
Female
|
448
|
43.37%
|
Age Group
|
||
<18
years
|
145
|
14.04%
|
18-27
years
|
317
|
30.69%
|
28-37
years
|
269
|
26.04%
|
38-47
years
|
156
|
15.10%
|
48-57
years
|
85
|
8.23%
|
58
and above years
|
61
|
5.90%
|
Habitat
|
||
Rural
|
929
|
89.94%
|
Urban
|
104
|
10.06%
|
Religion
|
||
Islam
|
964
|
93.32%
|
Hinduism
|
69
|
6.68%
|
Others
|
||
Marital Status
|
||
Married
|
668
|
64.67%
|
Unmarried
|
339
|
32.82%
|
Widow
|
21
|
2.03%
|
Divorced
/ Separated
|
5
|
0.48%
|
Table-2: Distribution of Patients by Educational Status.
Particulars
|
Number
|
Percentage
|
Illiterate
|
319
|
30.88%
|
Primary
|
199
|
19.27%
|
Secondary
|
281
|
27.20%
|
SSC
/ HSC
|
181
|
17.52%
|
Graduation
& above
|
53
|
5.10%
|
Table-3:
Distribution of Patients by Occupation
Particulars
|
Number
|
Percentage
|
Agriculture
|
90
|
8.71%
|
Service
|
54
|
5.23%
|
Business
|
99
|
9.58%
|
Teacher
|
21
|
2.03%
|
Student
|
167
|
16.17%
|
Day
Labor
|
13
|
1.26%
|
Works
Abroad
|
15
|
1.45%
|
Unemployed
|
139
|
13.46%
|
Housewife
|
387
|
37.46%
|
Others (Technicians / Shoe
makers/Plumbers /Weavers/Carpenters/Imam/etc.)
|
48
|
4.65%
|
Table-4:
Distribution of Patients by Family History of Psychiatric illness, History of
Smoking, Substance use and Referred from other departments.
Particulars
|
Number
|
Percentage
|
Family
History of Psychiatric Illness
|
219
|
21.20%
|
History
of Smoking
|
235
|
22.75%
|
History
of Substance Use
|
47
|
4.55%
|
Referred
from other Departments
|
208
|
20.14%
|
Table-5:
Types of Psychiatric Disorder among the Psychiatry Outpatients
Sl.#
|
Disease
|
Male
|
Female
|
Total
|
%
|
1
|
Generalized anxiety Disorders
|
103
|
66
|
169
|
16.36%
|
2
|
Other Anxiety Disorders
|
40
|
34
|
74
|
7.16%
|
3
|
Obsessive Compulsive Disorders
|
13
|
13
|
26
|
2.52%
|
4
|
Major Depressive Disorders
|
68
|
96
|
164
|
15.88%
|
5
|
Bipolar Mood Disorders
|
57
|
28
|
85
|
8.23%
|
6
|
Schizophrenia
|
43
|
40
|
83
|
8.04%
|
7
|
Brief Psychotic Disorders / Schizophreniform Disorders
|
44
|
43
|
87
|
8.42%
|
8
|
Acute Stress Disorders
|
2
|
6
|
8
|
0.77%
|
9
|
Post Traumatic Stress Disorder
|
1
|
0
|
1
|
0.10%
|
10
|
Somatoform Disorders
|
11
|
33
|
44
|
4.26%
|
11
|
Conversion Disorders
|
3
|
12
|
15
|
1.45%
|
12
|
Insomnia
|
11
|
0
|
11
|
1.06%
|
13
|
Psychosexual Disorders
|
56
|
0
|
56
|
5.42%
|
14
|
Extra-pyramidal Syndrome
|
6
|
2
|
8
|
0.77%
|
15
|
Adjustment Disorders
|
1
|
2
|
3
|
0.29%
|
16
|
Mental Retardation
|
4
|
2
|
6
|
0.58%
|
17
|
Epilepsy
|
18
|
2
|
20
|
1.94%
|
18
|
Attention Deficit Hyperactivity Disorders
|
3
|
4
|
7
|
0.68%
|
19
|
Autistic Disorders
|
2
|
1
|
3
|
0.29%
|
20
|
Conduct Disorders
|
4
|
4
|
8
|
0.77%
|
21
|
Hyperventilation
|
1
|
1
|
2
|
0.19%
|
22
|
Tension Headache
|
15
|
13
|
28
|
2.72%
|
23
|
Migraine
|
11
|
17
|
28
|
2.72%
|
24
|
Post Partum Psychosis
|
-
|
1
|
1
|
0.10%
|
25
|
Delusional Disorders
|
-
|
2
|
2
|
0.19%
|
26
|
Personality Disorders
|
-
|
2
|
2
|
0.19%
|
27
|
Substance related Disorders
|
22
|
2
|
24
|
2.33%
|
28
|
Abnormal Grief
|
3
|
3
|
6
|
0.58%
|
29
|
Deliberate Self Harm – poisoning
|
2
|
1
|
3
|
0.29%
|
30
|
Dementia
|
6
|
0
|
6
|
0.58%
|
31
|
Head Trauma
|
1
|
1
|
2
|
0.19%
|
32
|
Post Coital Headache
|
2
|
0
|
2
|
0.19%
|
33
|
Others (Neurological / Physical illness undiagnosed/ etc.)
|
32
|
17
|
49
|
4.74%
|
TOTAL
|
585
|
448
|
1033
|
100.00%
|
DISCUSSION
Most patients
were between 18-37 years age group 56.75%, literate 69.12%, married 64.67%,
housewife 37.46%, the finding is consistent with national study carried out by
National Institute of Mental Health.2 Table-1 shows number of male patients
(56.63%) is higher than female (43.37%). In our country females usually do not
seat health case as readily as male.7 This reflects the attitude of society
towards female. Anxiety disorders 23.52% and major depressive disorders 15.88% were
the common disorders requiring treatment in the psychiatry outpatient
department in a tertiary hospital situated in the rural area which is similar
to the psychiatric co-morbidity among Bangladeshi rural population.8
Most of the cases male suffered more than female though in few cases of major
depressive disorder with conversion disorder 1.45% female suffered more than
male. Next to depressive illness bipolar mood disorder 8.23%, schizophrenia
8.03%, brief psychotic disorder and schizophreniform disorder 8.42% are psychotic
disorder requiring admission in the hospital.9
Schizophrenia is a disorder which causes significant impairment of both social
and occupational functioning, if managed properly will be able to lead a
productive life in the society. Patients with depressive disorder, bipolar mood
disorder, substance related disorders 2.32% are serious burden to family and
society and threat to national economy, therefore their management is
important.
Study
revealed that major depressive disorder, somatoform disorders (4.26%) and
conversion disorder (1.45%) were more among female probably because of
stressful life events, the effect of child birth and learned helplessness
(5.8). The number of patients with somatoform disorders, conversion disorder,
tension headache (2.71%), migraine (2.71%) found less among the total number of
patients. This correlates with the false belief of the patients regarding their
symptoms as being physical rather than psychological.9
These patients also seek health care from other outpatient departments of this
hospital. The child psychiatric disorders like attention-deficit hyperactive
disorder 0.68%, autistic disorders 0.58%, mental retardation 0.58%, early
diagnosis and proper management is essential to improve the quality of life of
these children.9 Epilepsy
1.94% also being treated by different outpatient department of this hospital,
early management reduces suffering and disability of the patients, helps to
lead normal life. Patients with psychosexual disorders 5.42% also seek care
from dermatology outpatient department. Only 6 cases of dementias were being
treated throughout the year, probably due to lack of awareness regarding the
problem and its management among the rural people.
Psychiatric
morbidity was highest among housewife 37.46% because of stressful life event,
child rearing, housekeeping and learned helplessness.9
Students 16.17% who were mostly adolescent and of early adultness and therefore
vulnerable for psychiatric disorders. Next to student, psychiatric morbidity
were frequent among unemployed 13.46%, because these people are facing daily
life stresses.6 21.2% patients had positive family
history of psychiatric illness, indicating major psychiatric disorders have
substantial contribution of genetic heritability.
CONCLUSION
This study
though gives a pattern of different psychiatric disorders among the rural
people in Bangladesh, a community based study is essential to delineate the
exact picture. Only hospital based study can not reflect the exact picture,
because some of the patients do not seek hospital based treatment because of
stigma, some cannot afford such treatment, some are unaware about the
availability of the treatment and probably a good number of patients seek
alternative treatment for psychiatric morbidity. Psychiatric problem is at
present a national issue, awareness about the illness is gradually increasing.
So number of patients seeking psychiatric treatment is also increasing. To meet
this need facility of the mental health services should be available for all.
________________________________________________________________________________
a.
Assistant Professor, Psychiatry. Jahurul Islam Medical College & Hospital,
Bajitpur, Kishoregonj
b.
Registrar, Medicine. Jahurul Islam Medical College & Hospital, Bajitpur,
Kishoregonj
________________________________________________________________________________
Corresponding
Author: S. Abdullah Al-Farooq, Assistant
Professor, Department of Psychiatry, Jahurul Islam Medical College &
Hospital, Bhagolpur, Bajitpur,
Kishoregonj. E-mail: farooq.jimch@gmail.com
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Nahar
JS, Morshed NM, Qusar MMAS, et Al. Psychiatric morbidity among rural and urban
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Gelder
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