Consultation liaison psychiatry at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To describe the psychiatric services offered at Kenyatta National Hospital and the types of patients and cases seen at Kenyatta National Hospital. DESIGN: A retrospective study based on case notes and other hospital records. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: All patients seen in the various psychiatric clinics and those who attended the Patient Support Centre Unit in the hospital in the year 2002. RESULTS: In the year 2002, 598,119 patients were treated at KNH out of which 6,878 (1.15%) were seen in the psychiatric clinics: 1,709 adults and 1,412 children were referred to the various psychiatric clinics. At the hospital's Patient Support Centre (PSC) 3,454 patients were seen, mostly for pre and post-HIV test counselling. Consultations from the wards accounted for 332 (9.6%) of the cases referred to PSC. The main diagnoses among the latter in order of frequency were alcohol related psychiatric disorders, acute and transient psychoses, depressive disorders, dissociative and conversion disorders and dementia. CONCLUSION: In view of the high load of acute and transient psychotic states, as well as substance related disorders, it is recommended that the hospital should establish acute wards for the comprehensive management of such patients. An alcohol and drug detoxification and rehabilitation centre should also be developed at the hospital. Services to those with HIV related disorders should also be improved.

How Kenyan physicians treat psychiatric disorders.

OBJECTIVES: To determine the psychological problems the non-psychiatric doctors commonly encounter, the treatment offered and/or referrals made and to determine any obstacles met in providing psychiatric treatment or making referrals. DESIGN: Cross-sectional survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Doctors working at Kenyatta National Hospital. RESULTS: One hundred and thirty (94 males and 36 females) doctors submitted usable questionnaires. Seventy eight per cent of the respondents were below 35 years and 57 had less than five years experience. The commonest psychiatric disorders seen by doctors were anxiety, depression, psychosomatic disorders and organic psychoses similar to findings in previous prevalence studies. Drugs therapy with anxiolytics antidepressants and antipsychotics were commonly utilised. Brief counselling was the verbal form of treatment most commonly used. Referral to mental health workers was less often done. Obstacles cited by the doctors were the patients' resistance to referral, lack of coordination and insufficient knowledge to treat the disorders. CONCLUSION: The doctors recognise that psychiatric disorders are common among their patients but they have major obstacles in managing them. These findings are discussed and remedial measures suggested.