Total Viewers

Thursday, September 29, 2011

Psychiatric Morbidity: Diagnoses of the Patients attending Psychiatry Outpatient Department of a Hospital

___________________________________________________________
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
The greater number of population of our country mainly resides in the rural areas. Availability of the mental health services is inadequate in comparison to the need and it is almost unavailable in the rural areas. Previously in our country there were some studies among limited population groups regarding mental illness. In one study 29.% of the patients attending general practice were suffering from functional disorders and 6% from both functional and organic disorders. Among the sufferers 47% patients were neurotic, 37% psychosomatic, 10% were suffering from mood disorder, 1.44% schizophrenia, 2.88% alcohol and other substance related disorders, 2% organic psychiatric syndrome.3

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

REFERENCES

1)     Ahsan MN, Karim ME, Alam MF et al. (eds) Souvenir World Mental Health Day 10 October 1999.
2)     Firoz AHM, Karim ME, Alam MF, et al. Community Based Multi-centric Service Oriented Research on Mental Illness with focus on Prevalence, Medical Care, Awareness and Attitude towards Mental Illness in Bangladesh. WHO published data 2003-2005. Bang J Psychiatry 2006; 20(1): 9-32.
3)     Alam MN. Psychiatric Morbidity in General Practice. Bangladesh Med Res Counc Bull 1978; 4(1): 38-42.
4)     Chowdhury AKMN, Alam MN, Ali SMK. Dasherkandi Project Study – Demography, Morbidity and Mortality in a rural community of Bangladesh. Med Res Counc Bull 1981; 4(1): 22-39.
5)     Mohit MA. Diagnosis of patients attending outpatient department (OPD) of NINH. Bang J Psychiatry, June 2001; 15(1): 5-12.
6)     Fahmida A, Wahab MA, Rahman MM. Diagnostic Patter of Patients admitted in private psychiatric clinic. Bang J Psychiatry December 2007; 21(2): 26-32
7)     Islam HA, Review of 5153 Treated Psychiatric Patients – A five year retrospective study. Bangladesh. Med Res Counc Bull 1977; 3(1): 52-59.
8)     Nahar JS, Morshed NM, Qusar MMAS, et Al. Psychiatric morbidity among rural and urban population – A comparaitve study. Bang J Psychiatry December 2005; 19(2): 19-27.
9)     Gelder M, Harrison P, Cowen P (editors) Oxford Shorter Textbook of Psychiatry. 5th ed Oxford University Press, 2006.

1 comment:

  1. To get MBBS admission in Bangladesh is a right choice for the Indian students willing to become good doctors due to the lowest fee structure, affordable cost of living and a lot of opportunities to the students. The MBBS degree from Bangladesh is valid in India and all other countries in the world.

    ReplyDelete