Psychiatric morbidity in children reporting at a tertiary care hospital

ABSTRACT

The study is designed to assess the psychiatric morbidity in children reporting at psychiatry OPD, of National Institute of Child Health [NICH], Karachi. Simple descriptive study. This study was conducted during the period of two years from January 2005 to January 2007 at National Institute of Child Health [NICH] Karachi. All consecutive patients who reported in child psychiatry clinic were enrolled in this study if they fulfilled the inclusion criteria having age of 3 years to 15 years of either sex. Cases excluded in the study were psychiatric presentation associated with physical illness and symptoms related to drug side effects. The facility received direct referrals from other professional colleagues, and from parents, school teachers who have been sensitized to child psychiatric issues. Semi-structured interview based on DSM-IV along with an open ended slot of question were used for evaluation. Data regarding demographic characteristics, referral source, reasons for referral and diagnostics based on clinical judgment were collected. Five hundred and seventy new cases were inducted in this study over a period of two years. Males outnumbered females with the ratio of 1.71. Majority [42.28%] of children were in the age range from 11-15 years. Standard deviation of age was 6.8 years for male and 3.5 years for female children. Most [69.6%] of the referrals were made from professionals working in pediatric medicine. The most common reason for referral was disruptive behaviour [26.32%], followed by behavioural problem with fits [15.79%] and physical over activity [7.89%]. Other presenting complaints [reasons for referral] included slow learner, self injurious behaviour, aggression, speech delay, unexplained physical symptoms, bed wetting, emotional problems poor attention and tics etc. Mental retardation with behavioural problem was the most frequent [36.14%] provisional diagnosis. About 16.14% of cases related to seizure disorder with behavioural problem while 10.53% were attention deficit hyperactivity disorder [ADHD]. Other diagnoses made were depressive illness, conversion disorder, functional enuresis and autism. After mental retardation, one third of cases comprised of seizure disorder with behavioral problem, attention deficit hyperactivity disorder [ADHD], and depressive illness. It is therefore recommended that professionals at primary health care level should be trained to identify psychiatric illness in children so that early intervention, proper referral and effective management may be possible