Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Abstract

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry, they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that, in some cases, MUS may be ascribed to Somatoform Disorders when, fact, they are "organic" syndromes that are misdiagnosed. In developing countries, with fewer resources, MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics, referral pathway, management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5% of the total number of files reviewed. In only 38% of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28% of cases a new "organic" diagnosis was made and in 72% of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with "organic" illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA, a significant number of patients with MUS may have underlying "organic" illness, and most may have psychiatric disorders. Patients with MUS, especially older patients, should be more extensively investigated. Psychiatric referral of these patients is very appropriate.

Psychiatric Morbidity Patterns in Referred Inpatients of Other Specialties

“…17 Similar is the case in Brazil and South Africa, where psychiatric referral has been found to be less in comparison to that in Western Hospitals. 12,13 Psychiatric referral rate in our centre can be considered somewhat encouraging keeping in mind the facts we received from the earlier studies done elsewhere. Referral rates in the summer months (March to May) was maximum in comparison to the other months of the year which can be attributed to the fact that self-poisoning which is the most common medical diagnosis (30.6%) among these patients is also higher in these months leading to increase in the Psychiatric referral load; it corroborates with the findings in our study done last year in the same centre looking into the psychiatric profile of the patients presenting with Intentional self harm.…”

“…17,18 Even the studies done in India, other South American and African regions show differences in referral rates in comparison to some other Western studies. [12][13][14][15][16] Keeping these facts in mind, we intended to conduct a study in our Teaching Hospital setting; to explore the referral patterns from other Departments to our Department of Psychiatry in order to initiate an attempt to understand the factors affecting the practices of Consultation-Liaison Psychiatry in our centre. In the study period of one year, we evaluated medical/ surgical and psychiatric diagnosis (if any) of the patients referred for psychiatric evaluation from other different wards in our hospital and tried to analyze the interrelationship between them and their primary source of referral; in addition to the descriptive analysis of the socio-demographic profile and treatment related factors of those subjects.…”

“…do not show comparable results. [11][12][13][14][15][16] Similarly, literature looking into the factors leading to the lower referral rates in Psychiatry is sparse and inconclusive. [17][18][19][20][21][22][23][24] Keeping this in mind, this study was undertaken in a University Teaching Hospital setting with the aim to evaluate the patterns of referral of inpatients from other specialties to the Department of Psychiatry and describe the apparent psychiatric morbidity patterns of those patients.…”

Pattern of psychiatric morbidity among referred inpatients in a tertiary care hospital of Bangladesh

“…Though it has been shown that the organization of consultation service and its efficiency are factors interfering with the rates of referral, studies looking into psychiatric referral patterns in different hospital settings do not show comparable results. [9][10][11]13,21 Besides, literature looking into the factors leading to the lower referral rates in Psychiatry is sparse and inconclusive. 21 Keeping this in mind, this study was undertaken in a tertiary hospital setting with the aim to evaluate the patterns of referral of inpatients from other specialties to the department of Psychiatry and describe the apparent psychiatric morbidity patterns of those patients.…”

“…8 Though it has been shown that the organization of consultation service and its efficiency are factors interfering with the rates of referral, studies looking into psychiatric referral patterns in different hospital settings do not show comparable results. [9][10][11] It is estimated that 21-26% of the medical outpatients have psychiatric disorder and life time prevalence of mental disorder in chronically physically ill patients is around 42%. 12 The incidence of mental disorders in hospitalized physically ill patients ranges from 5% to 50%.…”