Professional Documents
Culture Documents
DOI: 10.5455/2320-6012.ijrms20140512
Research Article
Department of Psychiatry, Surat Municipal Institute of Medical Education & Research (SMIMER), Surat - 395010,
Gujarat, India
*Correspondence:
Dr. Parag S. Shah,
E-mail: drparagsshah@rediffmail.com
© 2014 Shah PS. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-
Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium,
provided the original work is properly cited.
ABSTRACT
Background: Pattern of psychiatric disorders found among patients visiting the hospital helps in understanding the
epidemiology, heath seeking behavior as well as strategic service planning and development.
Methods: A retrospective health record review, of all the patients visiting out-patient care and in-patient care of
psychiatry department of a tertiary care hospital in a period of two years, was conducted to assess the prevalence and
trend of most common psychiatric disorders among them.
Results: Major depressive disorder and Alcohol use disorder were the most common conditions found in out-patient
and in-patient settings respectively. Out-patient consultations were consistently increasing whereas in-patient
admissions were variable and decreasing with time.
Conclusion: Current scenario and trends of psychiatric disorders among this group of patients is in line with
epidemiological patterns and reflects a healthy trend of community oriented (out-patient based) care.
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 439
Shah PS. Int J Res Med Sci. 2014 May;2(2):439-444
out-patient services along with round the clock past. Patient’s identity, personal data and the content of
emergency services and has a 15 bedded open ward for the record review was kept confidential.
acute and short term psychiatric care. Hospital based
general psychiatry services including comprehensive A systematic record review of all the consecutive patients
assessment and treatment of all psychiatric disorders are with each clinical condition consulting the out-patient
provided by a team of health professionals consisting of department or getting admitted in in-patient ward during
consultant psychiatrists, junior medical officers and each month was done by the author. Data thus extracted
nurses. Most of the patients visit the department directly was used to calculate average number of patients with
while some of them are referred by other departments of various clinical conditions visiting the hospital per
the hospital. A record of all the patients visiting the out- month, daily average patients in the out-patient and in-
patient and in-patient services is maintained using a patient as well as bed occupancy in the ward. Data was
structured Performa. also analyzed to understand the trend of variations in the
frequency of various clinical conditions in the out-patient
This study is a retrospective health record review of all / in-patient settings over the period of two years.
the patients visiting out-patient department and in-patient Descriptive analysis of the data was performed using
department in the period from June 2011 to May 2013, to simple frequency distribution charts.
understand the prevalence and trend of most common
psychiatric disorders among them. Ten most common It was observed that during the period of the study, the
clinical conditions (Schizophrenia, major depressive health services related factors like human resources,
disorder, bipolar mood disorder, alcohol use disorder, infrastructure, treatment facilities, cost of treatment or
other substance use disorders, anxiety disorders, advertisements, which could influence the health seeking
headache, epilepsy, sexual disorders and childhood behavior or consultations, were all constant.
psychiatric disorders) were identified from the previous
records. These conditions were previously diagnosed and RESULTS
registered in the medical records by the treating clinician
as per DSM-IV TR classification for mental disorders.1 In the time span of two years (from June 2011 to May
2013), there were 405 indoor psychiatric admissions and
Permission for reviewing the records was obtained from 18668 outpatient psychiatric consultations at Department
the departmental head. The review was conducted by of Psychiatry.
author who himself/herself was the treating physician in
Daily average
45
40
35
30
Number of patients
25
Out-patients
In-patients
20
15
10
0
June'11 Aug'11 Oct'11 Dec'11 Feb'12 April'12 June'12 Aug'12 Oct'12 Dec'12 Feb'13 April'13
Time period
Figure 1: Daily average of Out-patients and In-patients in the span of two years.
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 440
Shah PS. Int J Res Med Sci. 2014 May;2(2):439-444
Calculating average patients visiting the out-patient condition (32%), followed by schizophrenia spectrum
department, it was found to be 31 per day (range of 25 - disorders (17%), anxiety disorders (14%), headache
38) and average patients staying in the hospital were 6 (13%), alcohol use disorders (7%), bipolar mood
per day (range of 2-11). Figure 1 shows the pattern of disorders (7%), epilepsy (3%), childhood psychiatric
change in number of patients in the out-patient disorders (2%) and other substance use disorders (2%).
department and the in-patient department throughout the Whereas in in-patient settings alcohol use disorders were
period of two years. most common (29%), followed by schizophrenia
spectrum disorders (28%), major depressive disorder
Analyzing average number of type of patients visiting the (22%), bipolar mood disorder (7%), anxiety disorders
hospital per month, it was found that in out-patient (6%), other substance use disorder (3%) and epilepsy
settings major depressive disorder was the most common (2%).
35
30
25
Percentage
20
Out-patients
In-patients
15
10
0
Epilepsy
Anxiety Disorders
Childhood Psychiatric
Headache
Schizophrenia Spectrum
Major Depressive
Opioid/Cannabis/Nicotine
Bipolar Mood Disorder
Others
Disorder
Use Disorders
Disorders
Disorders
Clinical condition
Figure 2: Average Out-patients and In-patients with various clinical conditions per month.
Trend of Out-patients
350
300
50
0
July'11
May'12
July'12
May'13
Nov'11
Nov'12
June'11
Aug'11
Sep'11
Oct'11
Dec'11
Jan'12
June'12
Feb'12
March'12
April'12
Aug'12
Sep'12
Oct'12
Dec'12
Jan'13
Feb'13
March'13
April'13
Time period
Figure 3 (a): Trend of out-patients with various clinical conditions over two years.
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 441
Shah PS. Int J Res Med Sci. 2014 May;2(2):439-444
Trend of In-patients
14
12
0
July'11
May'12
July'12
May'13
Nov'11
Nov'12
Jun'11
Aug'11
Sep'11
Oct'11
Dec'11
Jan'12
Feb'12
March'12
April'12
June'12
Aug'12
Sep'12
Oct'12
Dec'12
Jan'13
Feb'13
March'13
April'13
Time period
Figure 3 (b): Trend of in-patients with various clinical conditions over two years.
Figure 3 (a) & (b) analyzes the trend of variations in the graph helps to understand any annual / seasonal pattern
frequency of various clinical conditions in the out-patient for any clinical condition or its correlation with one
/ in-patient settings over the period of two years. The another.
80
70
60
50
Percentage
40
30
20
10
0
June'11 Aug'11 Oct'11 Dec'11 Feb'12 Apr'12 June'12 Aug'12 Oct'12 Dec'12 Feb'13 April'13
Time Period
Average bed occupancy was found to be 40% over the different times of the year. During first year it was 43.39
time span of two years ranging from 17% to 72% at which reduced to 36.56 during the second year (p<0.01).
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 442
Shah PS. Int J Res Med Sci. 2014 May;2(2):439-444
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 443
Shah PS. Int J Res Med Sci. 2014 May;2(2):439-444
2. Bahn AK, Gardner EA, Alltop L, Knatterud GL, 5. Murali MS. Epidemiological Study of prevalence of
Solomon M. Admission and prevalence rated for mental disorders in India. Indian J Community Med.
psychiatric facilities in four register areas. Am J 2001;26(4):198-200.
Public Health. 1966;56(12):2033-51. 6. NHS Information Centre. Psychiatric morbidity in
3. Thompson A, Shaw M, Harrison G, Davidson Ho, England: Results of a household survey, 2007.
Gunnell D, Verne J. Patterns of hospital admission Available at:
for adult psychiatric illness in England: analysis of http://www.esds.ac.uk/doc/6379/mrdoc/pdf/6379res
Hospital Episode Statistics data. Br J Psychiatry. earch_report.pdf. Accessed October 2008.
2004;185:334-41.
4. Reddy MV, Chanorashekar CR. Prevalence of DOI: 10.5455/2320-6012.ijrms20140512
mental and behavioural disorders in India: A meta- Cite this article as: Shah PS. Trend of psychiatric
analysis. Indian J Psychiatry. 1998;40 (2):149-57. disorders among out-patients and in-patients of a
tertiary care center of India. Int J Res Med Sci
2014;2:439-44.
International Journal of Research in Medical Sciences | April-June 2014 | Vol 2 | Issue 2 Page 444