Medical evaluation abnormalities in acute psychotic patients seen at the emergency department of Muhimbili national hospital in Dar es Salaam, Tanzania

Abstract

Prior studies have shown varied rates of medical pathology in patients presenting to acute care settings with psychotic symptoms, and there is almost no literature from the sub-Saharan Africa region. We investigated the yield of physical examination and laboratory testing among patients presenting with acute psychosis to an urban ED in Dar es Salaam. Methods: This was a prospective observational study of patients presenting to the ED at Muhimbili National Hospital with acute psychosis. A standardized data form was used to prospectively collect demographics, history, physical examination, and diagnostic test results. Data were entered into Excel (Microsoft Corporation, Redmond, WA, USA) and analysed with SAS (SAS Institute Inc., Cary, NC, USA). Results: We enrolled 252 participants from August to October 2012, mean age 32 (±11) years, and 69% male. Overall, 161 (64%) had a history of psychiatric illness and 137 (54%) were on psychiatric medication. Comorbidities included dementia (6), HIV (5), recent trauma (5), diabetes (2), CVA (1), and other chronic medical conditions (21). The most common physical examination findings were skin abnormalities (11% of patients), including infections, bruises, cuts, lacerations and rashes. Of patients undergoing laboratory investigations, 39/206 (19%) had abnormal lab findings and 27/39 (69%) were clinically significant, including positive HIV tests (9), abnormal blood chemistries (7), positive malaria tests (5), abnormal full blood picture (4), and abnormal blood glucose levels (3). Conclusions: In our cohort, history and physical examination findings were not sufficient to rule out serious medical conditions among patients presenting with acute psychosis. The observed rate of laboratory abnormalities was higher than previously published rates from high-resource settings. Based on our findings, patients presenting with psychosis to an acute care facility in this region should be evaluated with physical examination and laboratory studies to rule out serious underlying medical pathology.