Pattern of Psychiatric Referral From Emergency Department of a Tertiary Level Hospital in Nepal

Abstract

INTRODUCTION: Emergency department serves as one of the gateway through which patients with psychiatric disorders come for treatment. The referral to the psychiatry department enables a psychiatrist to provide services to these patients in need. So, the study of this pathway of care becomes important. MATERIAL AND METHODS: A total of 100 consecutive patients referred from emergency to the department of psychiatry were enrolled in this study. Their socio-demographic variables, reason and purpose for referral was assessed. The psychiatric diagnosis was made according to the International Classification of Diseases -10 (ICD-10) system. RESULTS: The psychiatric referral rate from the emergency was found to be 8.46%. Out of one hundred patients more referred patients were female (64%), from rural background (90%). Family members were the source of referral for emergency visit in most of the patients (74%). Dissociative disorder was the most common diagnosis (26%) followed by acute & transient psychotic disorders at 12%. CONCLUSIONS: Fewer patients are referred to psychiatry department even in a tertiary level hospital of Nepal. Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10 Page : 5-9

Prevalence and nature of psychiatric referrals from Intensive Care Unit of a teaching hospital

“…23 In our study AUD was the most common diagnosis seen in 22% of subjects. AUD is common disorder referred for assessment to a psychiatrist from ICU 15 , emergency department 24 and from other departments. 25 Substance use disorders including alcohol are one of the common disorders that need psychiatry evaluation and treatment.…”

Clinical practice guidelines for assessment and management of dissociative disorders presenting as psychiatric emergencies

“…Studies have shown that among all psychiatric referrals in emergency settings, a call for the assessment of suspected dissociative disorder is the most common. [ 7 ] The tendency of dissociative disorders to emulate physical disorders makes assessment especially tricky. A wide range of medical conditions could mimic symptoms of dissociative disorders, medical conditions may produce and/or exacerbate psychiatric symptoms in patients already suffering from a mental illness, patients with pre-existing medical conditions can develop psychiatric symptoms and occasionally medical conditions and dissociative disorders can arise together.…”

Comments on “Utilization of Emergency Psychiatry Service in a Tertiary Care Centre in North Eastern India: A Retrospective Study”

“…[8] There are many recent works on emergency psychiatry presentations which state that schizophrenia, substance use disorders, mania, and dissociative symptoms are the common presenting illnesses at the emergency department, rather than the somatoform disorder. [9][10][11][12] These recent works on psychiatric emergency clearly state a presentation and profile of the psychiatric emergency patients, which differ largely from the profile stated in the article by Naskar et al [1] The description of "Distribution of the various reasons for referral from various departments," in Naskar et al, [1] states that 22.38% of patients referred by other departments had a previous psychiatric illness. [1] It would have been more informative if the authors had provided the reason for referral to the psychiatrist, as there is a possibility that the readers may misinterpret that these patients would have been sent for just repeating the prescriptions of psychotropics since they are in the hospital for other medical illnesses.…”

“…[8] There are many recent works on emergency psychiatry presentations which state that schizophrenia, substance use disorders, mania, and dissociative symptoms are the common presenting illnesses at the emergency department, rather than the somatoform disorder. [9101112] These recent works on psychiatric emergency clearly state a presentation and profile of the psychiatric emergency patients, which differ largely from the profile stated in the article by Naskar et al [1]…”