Psychiatric morbidity among medical in-patients at Kenyatta National Hospital

Abstract

The number of beds in psychiatric hospitals in developed countries has dropped from the peak in the 1950's. This is perhaps in part due to increase in the use of psychotropic drugs and other measures such as the breaking down of barriers between mental hospitals and the community which have enabled patients to return to their homes. The development of intercurrent illnesses or an accident in patients or in other people who are just coping with psychiatric morbidity may result in admission to a general hospital where a crisis may arise in the course of managing the psychiatric component of the illness (Macleod et ale 1968). Psychiatric services to the general medical wards are usually based on referrals initiated by physicians (Maguire et ale 1974). Yet medical staff probably fail to recognize, treat or refer many of those patients who might benefit from psychiatric help (Schwab et ale 1965, Lipowski 1967) even when they liaise closely with psychiatrist. This study was undertaken with the aim of providing data on-the psychiatric morbidity, its relationship to use of traditional healers, and drug use/abuse amongst medical in-patients at Kenyatta N3tional Hospital. Having reviewed the literature, CW0~hypotheses were fomulated and tested. These were:

1. Affective disorders are the commonest psychiatric illnesses encountered. 2. The majority of psychiatric cases go undetected. The study was carried out in the Kenyatta National -Hospital Medical wards using a two-stage screening procedure. First, a locally validated version of the self-rating questionnaire (SRQ) (Harding et al. 1980, Dhadphale M. 1984) was used to screen the patients and a standardised psychiatric interview (SPI) used to confirm the cases. The psychiatric diagnoses were based on the leD 9 diagnostic criteria. A total of 200 patients were interviewed. The significant findings were: 1. 22% (44) of the total sample of 200 patients who were interviewed met the pre-established criteria for psychiatric morbidity. 2. Affective disorders were the commonest and comprised 59.0% of the psychiatric morbidity cases. 3. 9% (4) of the psychiatric morbidity cases were referred for psychiatric evaluation. This worked out at a referral rate of 2% for the whole sample of 200 patients.

4. The~majority of patients with psychiatric problems had relatively "minor" disorders, namely anxiety states (18.2%) and depression (59.09%). 5. Although 17% of the patients had been to a traditional healer, a comparison between the number of psychiatric morbidity cases among the patients who had been to a traditional healer and the rest of the patients yielded no statistically significant difference. This comparison was also done between the patients who had been to a traditional healer and those that had not for psychosomatic illness again with a similar result. 6. 26% (52) of the patients interviewed had smoked cigarettes in the preceding 6 months with 30% of them smoking more than 1 packet a day. 7. Use of cannabis and khat was very limited, amounting to 3% (6) of all patients in each case. 8. Using W.H.O Core Screening Instrument for Alcohol (A.U.D.I.T.), 17% (34) of the patients interviewed scored significantly for a positive case of harzardous or harmful alcohol intake; only 4 patients of the 34 were female. Of note was the multiple drug use/3buse of alcohol, khat, cannabis and tobacco in varying combinations.

As it would be unrealistic to expect all patients with psychological problems to be referred for management by psychiatrists, simple training in symptom recognition and management of some of the psychological problems is suggested, for the non-psychiatric health workers who are in constant contact with these patients. Health education and psychotherapy for the drug users is recommended. The role of the traditional healer still needs to be evaluated before integration with the western orientated medicine.