RESUMEN
Background&Objective:To study the patterns of psychiatric referrals in a newly established tertiary care teaching Hospital has been important for understanding consultation liaison psychiatry and setting up better general hospital psychiatric units. The aim of the present study was to study referral characteristics’ of patients of various departments to psychiatric unit at a tertiary care teaching hospital.Methodology:All referrals made to psychiatry department over a period of one year were assessed by psychiatrist based on structured performa including demographic data, referring department, referral note, present complaints, past history of psychiatric illness, family history of psychiatric illness, mental status examination and DSM –IV-TR criteria to diagnose psychiatric illness and analyzed.Results:Out of 400 referred patients to psychiatry unit over a period of one year, majority were from Medicine department (62.75%). Substance use disorder (37.25%) was the most common diagnosis followed by depressive disorders (15.75%) and anxiety disorders (8.25%). 235 (58.75%) references were with statement like ‘psychiatry reference’ and no reason mentioned for that. Significantly higher proportions of OPD referrals (71.81%) were made with statement like ‘psychiatry reference’ and no reason mentioned for that as compared IPD referrals (41.62%). Significantly higher proportions of patients (66.75%) with past history of psychiatric illness were referred with statement like ‘psychiatry reference’ and no reason mentioned for that as compared to patients (52.81%) without past history of psychiatric illness. Conclusion:Study highlights importance of consultation-liaison psychiatry through referral pattern in a tertiary care teaching hospital. More referrals for Substance use disorders suggest emerging need to develop separate deaddiction services in our setting. Past history of psychiatric illness was considered significant factor for referrals from other departments and majority of references were without any details. There is need to sensitize other specialists, especially general physicians who are the common source of referrals regarding common psychiatric conditions and proper referral note to improve consultation liaison psychiatry in general hospital setup.
RESUMEN
Background: Epidemiological data are limited regarding clinical characteristic of adverse drug reactions (ADRs) in India. Aim: The aim was to assess ADRs with reference to the causative drugs, seriousness and their other clinical characteristics in Indian tertiary care teaching hospital. Methods: A spontaneous reporting based ADR monitoring study was conducted over a period of 2 years. The World Health Organization (WHO) definition of an ADR and its seriousness was adopted. The organ system involvement was labeled by WHO-ADR terminology. ADRs were analyzed for causality by Naranjo’s algorithm, preventability by modified Schumock and Thornton’s criteria and types of reactions by Rawlins and Thompson classification. Subgroup analysis was performed between serious and non-serious reactions. Results: Of the total of 135 reactions reported 111 reactions from 97 patients were included for analysis. The incidences of overall and serious ADRs were 0.25 and 0.06 per 1000 patients, respectively. The most commonly implicated organ systems were skin and appendages (52.25%). The major causative drug classes were antimicrobials (40.28%), central nervous system (23.61%) and autacoids (15.97%). About twothirds of the reactions (65.77%) were classified as probable and one-tenth (8.10%) as preventable. The factors significantly associated with serious reactions were age group 40-60 years (odds ratio [OR]: 5.51), parenteral drugs (OR: 2.96), central and peripheral nervous system disorders (OR: 5.06), body as a whole - general disorders (OR: 9.05) and acute onset reactions (OR: 52.62). Conclusion: Antimicrobials are common causative agents. Cohort study is recommended to confirm the risk factors of serious ADRs in Indian population.