Record review of occurrence of physical illness in patients at a specialist psychiatry outpatient clinic
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Date
2021
Authors
Melapi, T A S
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Abstract
Background: Physical illnesses continue to be a major cause of morbidity and early, higher mortality among people with Severe Mental Illness (SMI). Physical and psychiatry illnesses interact in various ways. These include bidirectional causality, health system and healthcare worker-related factors. Currently, there is limited data regarding existence of physical illnesses in South African psychiatry patients. This study sought to investigate the extent to which physical illnesses, in people with SMI, are documented and reviewed at a psychiatric outpatient clinic. Objectives: This study aimed to describe demographic characteristics, clinical profile and documented physical illnesses in this study group and determine any possible associations between the group’s demographic variables and their various documented comorbid medical illnesses. Method:
This was a retrospective, descriptive record review of files of patients who attended the psychiatry outpatient department over a six-month period in 2012. Results: Forty-three percent (n=266) of the 608 patients who attended the clinic during the study period had a recorded physical illness. Of the 266,24.1% had an Axis 1 diagnosis due to a general medical condition, while 75.9% had a primary Axis 1 diagnosis with a co-morbid general medical condition. Their average age was 48 years and 67% of them were female. Their marital status, highest level of education and employment status were mostly not documented (57%, 62% and 56.4% respectively). The most common five main Axis I diagnoses were dementia (13.16%), major depressive disorder (12.78%), psychosis due to GMC (11.28%), bipolar mood disorder (9.40%) and major depressive episode (9.02%). The five most commonly diagnosed co-morbid physical illness were hypertension (40.2%), epilepsy (18.4%), HIV/AIDS (15.4%), dyslipidaemia (11.2%) and diabetes mellitus (10.2%). There was a statistically significant association noted between age and hypertension(p-value=0.00), diabetes mellitus (p-value=0.04), HIV (p-value=0.00) and epilepsy (p-value=0.01). Conclusion: This study helps clinicians gain some insight into which physical illnesses are present in psychiatric patients. The study also highlights how these physical illnesses may relate to the psychiatric diagnoses that the clinicians are treating. Future studies may focus on the relationship between psychiatric medication and physical illnesses and on policies in managing physical illnesses in people with mental illnesses
Description
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry, 2021