Pattern of Psychiatric Referral in a Tertiary Care Hospital in Bangladesh

Abstract

Introduction: Consultation-liaison Psychiatry (CLP) is the study, practice and teaching of the relationbetween medical and psychiatric disorders.
 Aim of the study: The aim of this study is to find out the referring department, reason for consultation,common psychiatric comorbidities and sociodemographic of the referred patients to psychiatrydepartment from the other departments of Bangabandhu Sheikh Mujib Medical University of Dhaka.
 Methodology: This cross-sectional study was carried out from May 2018 to February 2020. Patientsreferred from different inpatient departments every Thursday were taken as study population.Psychiatric diagnoses of the patients were assigned by the consultant psychiatrist as per DSM-5criteria. Semi structured questionnaire was used to collect socio-demographic data.
 Results: Among the referred patients (n= 89) 56% were female; 63% were aged between 19-59years; 65% were married; 58% were from urban background and 51% studied up to higher secondary.More than half of the patients were referred from different branches of Medicine (68%). Referral fromInternal Medicine was 14.6%, Rheumatology 13.5%, Neurology and Nephrology 10% respectively.The rest were from the branches of pediatrics, surgery and gynecology. Most common psychiatricdisorder was Major Depressive Disorder (37%) followed by Obsessive-Compulsive Disorder (17%)and Delirium (10.11%). 15% patient received no psychiatric diagnosis.
 Conclusion: Psychiatric comorbidities in general medical illness are very common. CLP provides anopportunity to improve health outcomes for inpatients and reduce burden on the healthcare system.
 Bangladesh J Medicine July 2020; 31(2) :76-80

The Pattern of In-patient Referral in the Psychiatry Department of a Tertiary Care Hospital in Bangladesh

“…These factors motivate people to seek aid from a general physician or internist first, rather than psychiatrists. 7,10 The second highest referral came from the surgery and allied sciences while combined (78, 18.2%), along with the general surgery forming the most referred (19) among them which is relatively similar to other study findings. 10,12 Relevant literatures suggest that there is an increased risk of psychological distress, especially anxiety and depression in both preoperative and postoperative cases.…”

“…7,10 The second highest referral came from the surgery and allied sciences while combined (78, 18.2%), along with the general surgery forming the most referred (19) among them which is relatively similar to other study findings. 10,12 Relevant literatures suggest that there is an increased risk of psychological distress, especially anxiety and depression in both preoperative and postoperative cases. 13,14 But the lower referral rate from surgery might indicate the lack of proper evaluation or consideration for mental health status of the patient's undergoing surgery.…”

“…The similar and different findings in other studies may indicate the variety of accessibility of the specialist care depending on the demography. [5][6][7][8][9][10] Among the departments, Department of Internal Medicine constituted the majority of the referred patients (174, 40.6%). This pattern was also found by other studies in Bangladesh and India.…”

“…This pattern was also found by other studies in Bangladesh and India. 4,7,[10][11] This may be due to a higher rate of co-morbidity, as well as the stigma associated with mental disorders. These factors motivate people to seek aid from a general physician or internist first, rather than psychiatrists.…”

“…11 The next prevalent department was found to be neurology (47, 11.0%), which is similar to other studies. 10 The similarities of symptoms, as well as the bidirectional relationship of diseases between neurology and psychiatry might be the cause. 15 Though the evidence suggests high prevalence of psychiatric co-morbidities among patients with gynecological problems, the referral rate from the Gynecology was relatively low (24, 5.6%).…”