PSYCHIATRIC PATIENTS IN MEDICAL OPDs: A PHYSICIANS’ DILEMMA

Abstract

OBJECTIVES: To determine the frequency of patients with underlying psychiatric disorders presenting with unexplained vague physical symptoms to medical outpatient department (OPDs) at Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. METHODS: A total of 1049 consecutive patients were enrolled in this study, over a period of 6 months from 1st January 2016 - 30th June, 2016 in Medical OPD, Department of Medicine Unit II (Ward 6), JPMC, Karachi, Pakistan. Adults of all ages and genders, regardless of socio-economic and educational status, attending medical OPD with unexplained vague physical symptoms and giving informed consent were included in study. Exclusion criteria consisted of patients with frank psychosis and (proven and/or suspected) major organic diseases. RESULTS: Out of 1049 patients aged 14 years and above met our inclusion criteria, out of which 441(42%) were males and 608 (58%) were females. Out of 1049 enrolled patients, main underlying diagnosis were irritable bowel syndrome (n=357; 34%), somatization disorder (26.22%, n=75), depression (19.4%, n=204), hypochondriasis (11.6%, n=122), conversion disorder (6.7%, n=71) and globus hystericus (1.9%, n=20). Majority of the patients (64.5%, n=686) lived in home with income levels less than Rs. 25000. About 36.5% (n=383) patients were graduate and 63.5% (n=666) were non-graduates. CONCLUSION: Psychiatric illness constitutes a significant bulk of patients that come to medical OPDs with unexplained vague physical symptoms and therefore; be inferred that psychiatric patients prove to be a dilemma for physicians regarding how they should be approached and subsequently handled.

Keywords

• Irritable Bowel Syndrome (IBS)
• Somatization Disorder
• Depression
• Hypochondriasis
• Conversion Disorder
• Globus Hystericus