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

Abstract

Background:In a developing country like India, with a lot of psychosocial stressors and ample stigma toward psychiatry, we studied the sociodemographic pattern of the patients coming to a tertiary care center for emergency psychiatry services and also evaluated the types and pattern of emergency services provided to them. We also assessed the predominant presenting complaints with which patients presented at the emergency department, “reasons for referral” in an emergency by other departments, and types of psychiatric diagnoses in the patients.Subjects and Methods:Data were extracted retrospectively from the general emergency and psychiatry emergency register of Silchar Medical College and Hospital for 1 year and analyzed.Results:Out of 41,040 patients attending the hospital seeking emergency care, referral rate to the psychiatric emergency was only 2.8%. The commonest presenting complaint of subjects who were referred was “medically unexplained somatic complaints” (47.70%). The main reason for a referral from other departments was “no physical illness was detected” in the patient (38.59%). About 78.8% of the subjects were diagnosed as having a proper psychiatric illness, with the majority presenting with stress-related and somatoform disorders (F40–49) (43.45%).Conclusion:This study highlights various important parameters regarding emergency services being provided and their utilization by the patients attending a psychiatric emergency, which could be helpful for future policies and resource allocation for providing superior quality and cost-effective mental health care to the patients.

Profile of Patients Seen in Consultation-Liaison Psychiatry in India: A Systematic Review

“…Most of these studies reported the patient profile of inpatients ( n = 14), 4 – 17 with a few reporting the profile of the patients referred to the psychiatry outpatient department from other specialties, 11 and others reported patients seen by the CLP team in the emergency setting. 17 – 22 Occasional studies have reported profiles of both inpatient and outpatient referrals. 23 – 30 In terms of centers, the maximum number of studies ( n = 6) came from the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh.…”

“…The duration for which referral patterns have been described in various studies varied from 1 month to 84 months, with 13 studies reporting referral patterns for a duration of ≥1 year. 8 , 11 , 12 , 14 , 20 , 22 , 23 , 26 , 28 – 33 . Most studies focused on the referral patterns for all age groups, except for one study each that focused on geriatric 34 or pediatric 22 patients seen in the emergency department.…”

“…A few studies focused on screening all patients admitted to various medical-surgical wards or the emergency setting. 34 The sample size in different studies varied from 60 to 2355, with only nine studies 4 , 10 , 14 , 17 , 18 , 20 , 24 , 28 , 29 , 33 reporting data of more than 500 patients. The proportions of males in these studies varied from 30.9% to 88%.…”

“…Furthermore, some older studies reported the diagnosis as per the International Classification of Diseases (ICD), 9th revision (ICD-9), 4 , 8 , 19 , 27 whereas recent studies used the ICD-10 criteria. 5 – 7 , 9 , 11 , 14 , 15 , 17 , 18 , 20 – 23 , 25 , 26 , 28 – 33 Occasional study reported the diagnosis as per the Diagnostic and Statistical Manual (DSM) criteria. 36 A few studies have been silent about the criteria used to make the diagnosis.…”

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. [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]…”