Psychiatric Morbidity Profiles of Child and Adolescent Psychiatry Out-Patients in a Tertiary-Care Hospital.

Background: Psychiatric morbidity is ubiquitous, affecting children, adolescents and adults. Age factors play a great role in pattern of morbidity profile. Psychiatric morbidity profile of children and adolescents may indicate different needs and priorities. Objective: This study aims to sort out referral pattern, attitude about psychiatric referral and morbidity profile among child and adolescent psychiatric out-patients in a tertiary-care general hospital. Methodology: A total of 100 consecutive child and adolescent patients in psychiatry OPD coming into contact with investigator psychiatrist were enrolled during the study period. Diagnoses were made according to the ICD-10. Results: Fifty three of the subjects were female, majority of the cases (79) were of age between 13-18 years. Main ethnicity-caste groups seeking care were Mongol, Brahmin, Chhetri and indigenous Terai tribes. People from semi-urban and urban settings predominated in this study. Great majority (more than 80%) had reached this service in the 4th or in more than the 4th step of their help seeking. Most of the subjects were comfortable and happy about psychiatric referral. More than half had presented mainly with physical and somatic complaints. Major psychiatric diagnoses encountered were mood (affective), anxiety, seizure, dissociative conversion disorders and mental retardation. Four percent of subjects had suicidal behaviours and 17% migraine headache. Conclusion: Common psychiatric diagnoses among these child and adolescent out-patients are mood, anxiety, seizure, dissociative conversion disorders and mental retardation.

Psychiatric emergencies in a tertiary care hospital.

People with psychiatric problems often visit a general hospital. Many of them require emergency service. B P Koirala Institute of Health Sciences (BPKIHS) is one of the few health institutes in Nepal providing comprehensive 24-hour psychiatric emergency service. This study aims to document the pattern of psychiatric emergencies in a tertiary care hospital of Eastern Nepal. All psychiatric emergencies referred from different departments in 30 random days during a six-month period were enrolled. This is a descriptive study with convenience sampling method where the diagnoses were made based on the'International Classification of Disease and Infirmity' (ICD-10). One hundred twenty-nine cases were referred in the study period. The M:F ratio was 1.3:1. The service users were predominantly young adults. The majority of cases were seen in the emergency department and medical ward. The most common causes for the consultation were behavioral problems (39%), altered consciousness (32%) and somatic complaints (17%). Approximately 83% received the diagnosis of Category F of the ICD-10. Mental and behavioral disorder due to substance use (F10-19) was the most common disorder (30%), followed by mood/affective disorders (23%) and neurotic, stress-related anxiety disorders (16%). Roughly 46% had co-morbid physical illnesses and 8% received only a physical diagnosis. About 20% had attempted suicide using different means, poisoning being the most common. Emergency psychiatric consultation for mental problems is sought by almost all departments of a general hospital. These consultations are most commonly sought for substance use, mood or anxiety disorders.