Profile of Patients Seen in Consultation-Liaison Psychiatry in India: A Systematic Review

Prevalence of mental disorders in South Asia: A systematic review of reviews

Mental disorders are increasing in South Asia (SA), but their epidemiological burden is under-researched. We carried out a systematic umbrella review to estimate the prevalence of mental disorders and intentional self-harm in the region. Multiple databases were searched and systematic reviews reporting the prevalence of at least one mental disorder from countries in SA were included. Review data were narratively synthesised; primary studies of common mental disorders (CMDs) among adults were identified from a selected subset of reviews and pooled. We included 124 reviews. The majority (n = 65) reported on mood disorders, followed by anxiety disorders (n = 45). High prevalence of mental disorders and intentional self-harm was found in general adult and vulnerable populations. Two reviews met our pre-defined criteria for identifying primary studies of CMDs. Meta-analysis of 25 primary studies showed a pooled prevalence of 16.0% (95% CI = 11.0-22.0%, I 2 = 99.9%) for depression, 12.0% (5.0-21.0%, I 2 = 99.9%) for anxiety, and 14.0% (10.0-19.0, I 2 = 99.9%) for both among the general adult population; pooled estimates varied by country and assessment tool used. Overall, reviews suggest high prevalence for mental disorders in SA, but evidence is limited on conditions other than CMDs.

Pattern of Inpatient Consultation-liaison Psychiatry Utility in a Tertiary Care Hospital

Background

Consultation-liaison psychiatry (C-LP) is an interface between physical and psychological health where the psychiatrists become a part of the medical team for a holistic approach in the treatment of the patient.

Aims

Our study aimed to see the pattern and utility of C-LP services among inpatient referrals to the department of psychiatry.

Settings and Design

This observational descriptive study recorded inpatient referrals to the department of psychiatry of a tertiary care hospital for 2 months.

Subjects and Methods

The Mini-International Neuropsychiatric Interview (M. I. N. I.) was administered for identifying the comorbid psychiatric diagnoses.

Results

Most of the received inpatient referrals were for male patients (73.7%) in the age group of 30-60 years (58%). Overall, the referral rate was significantly higher from the emergency department and intensive care units (ICU) (50%), followed by specialty (medicine and surgery) wards (20%) and super specialty (cardiology, gastroenterology, and oncology) wards (16%). Altered sensorium and restlessness were the most common reasons for referral (42%), followed by alcohol/drug withdrawal (21.6%), somatic complaints (7.3%), sadness of mood, disturbed sleep, and deliberate self-harm (6% each). Substance use disorders, including alcohol and opioid (32%), delirium (25%), and depression (19%), were among the most common psychiatric diagnoses seen in the referred patients.

Conclusions

The pattern observed indicates that most inpatient referrals for psychological evaluation are received for altered sensorium from emergency and ICU than wards. The utility of C-LP helps to understand the reciprocal interdependence between the medical illness and the psychiatric comorbidity.

Patterns of Psychiatric Illness in a Tertiary Care Centre of Arunachal Pradesh: An Observational Study

Introduction:Monitoring the pattern of psychiatric illness among inpatients is essential for understanding the burden and trends of disease, in addition to designing and developing focused preventive and interventional strategies. Given the significant regional variation in the prevalence of mental illness, the present study evaluated the profile of psychiatric illness among inpatients admitted to a tertiary care center situated in the North East of India. Methods:Information from case records of consecutively admitted patients aged 18 years and above over the preceding three years, coded under the International Classification of Diseases, 10th edition (ICD-10), was reviewed. Details of socio-demographic parameters and psychiatric illness as well as substance use were extracted and represented by using descriptive statistics. Results:There were 371 admissions over the above-mentioned time frame. Subjects had a mean age of 36.5±10.45 years and 80.05% of them were males. Substance use disorders (77.62%) were the most commonly noted among study participants, with the majority being diagnosed with opioid dependence (43.93%) and alcohol dependence (29.92%), followed by tobacco dependence (2.16%). Psychotic disorders (5.12%), anxiety disorders (6.19%) and mood disorders (1.88%) were noted in a much lower proportion than anticipated. More than half (n=248) of subjects were aged 18-34 years. Conclusion:A disproportionate overrepresentation of substance use disorders among psychiatric inpatients in the North Eastern state of Arunachal Pradesh in India contrasts with the profile noted in other parts of the country. Notably affecting the younger age group, the findings of the present study highlight the need for the development of targeted preventive and interventional strategies to address the same. The study could help inform mental health policy initiatives and guide focused mental health care provision. These could include the establishment of centers for addiction medicine, enhancing training in addiction medicine for health professionals, counseling services and development of long-term rehabilitation for those suffering from substance use disorders.

Liaison psychiatry before and after the COVID-19 pandemic

INTRODUCTION

the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic.

MATERIALS AND METHODS

a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods.

RESULTS

patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004).

CONCLUSIONS

the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.

Delirium Research in India: A Systematic Review

Delirium is the most common psychiatric diagnoses encountered in patients with various medical-surgical illnesses, in all the treatment set-ups, with relatively higher incidence and prevalence in the intensive care units. As delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. This study aims to assess the research output involving patients of delirium from India. A comprehensive search was undertaken using Medline (PubMed) and other databases. Search words included were “delirium,” “delirious,” “delirium tremens” AND “India.” No filters were used. Internet and hand searches yielded 305 articles. Out of these articles, 151 had the terms “delirium,” “delirious,” “delirium tremens” in the title and these were included for the review. Additionally, 14 articles were included for the review, although these did not have these terms in the title, but delirium was one of the major outcome parameters in these studies. Majority of the papers were original articles ( n = 81), and these were followed by, case reports ( n = 58), review articles ( n = 10), letter to the editor (not as case reports but as a communication; n = 13), editorials ( n = 2) and one clinical practice guideline. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with occasional studies focusing on effectiveness of various pharmacological interventions. There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of nonpharmacological interventions, and evaluation of prevention strategies. It is the need of the hour to carry out more studies to further our understanding of delirium in the Indian context.