A retrospective review describing the proportion of medical patients who present with symptoms of psychosis in the medical admission ward at Tshepong Hospital

Abstract

Background: The literature shows that a small proportion of medical conditions present with a symptom of psychosis. However, in practice, a large proportion of human and financial resources are spent on investigating the aetiology of psychosis. Objectives: 1) To describe the socio-demographics and clinical characteristics of the study population. 2) To determine the proportion of patients admitted with psychotic symptoms and who had a discharge diagnosis of a primary psychiatric disorder or a secondary psychiatric disorder. 3) To describe the laboratory investigations that were conducted on all patients to exclude a medical illness on admission. 4) To calculate the total cost per patient for investigations done upon first contact, i.e., emergency department. Methods: A one-year retrospective review (6 April 2020 until 5 April 2021) was conducted. The data was collected from Tshepong Hospital. 317 patients were identified of whom 306 were included. The data was described using percentages, bar graphs and p-values. A p- value of <0.05 was deemed to be significant. Results: Most of this study’s population were males (77.45%), black ethnicity (78.14%) with an average age of 32.6 years and were unemployed (67.65%). 50.98% of the cohort used substances, with cannabis being the most consumed substance. 48.69% had a medical comorbidity, with HIV being the most common comorbidity, followed by hypertension. 24.52% had a history of psychiatric disease. Of those admitted with psychosis, 54.25% were discharged with a primary psychiatric disorder and 15.03% with a secondary psychiatric disorder. Urea, creatinine and electrolytes was the investigation that was done the most (n=225), followed by a full blood count (n=224). Two patients were tested for HIV. Other investigations done included calcium, magnesium, phosphate, liver function test, folate, vitamin B12, lipogram, urine drug screen and computed tomography. The total cost of the investigations amounted to R 282 498,90. The cost per patient of the primary psychosis discharge group was R 1135.55 and was R1209.36 in the secondary psychosis discharge group. Conclusion Most of those who presented with psychosis had a discharge diagnosis of psychiatric disease. We thus recommend the following 1) a screening questionnaire be implemented in the emergency department particularly for the psychotic patient. 2) adequate supervision of junior staff, 3) improving clinical skills and assessments by the medical team in the emergency department, thus, to practice targeted laboratory investigations. 4) the possibility of drafting a South African guideline to investigate psychosis that is tailored to local aetiologies.