One year prevalence of psychotic disorders among first treatment contact patients at Butabika National Psychiatric Referral Hospital in Uganda

ABSTRACTIntroductionHospital based studies for psychotic disorders are scarce in low and middle income countries. This may impact on development of intervention programs.ObjectiveWe aimed to determine the burden of psychotic disorders among first treatment contact patients at the national psychiatric referral hospital in Uganda.MethodsA retrospective patient chart-file review was carried out in March 2019 for all patients presenting to the hospital for the first time in the previous year. Patients were categorised into those with and without psychotic disorders. We collected sociodemographic data on age, gender, occupation, level of education, ethnicity, religion and home district. We determined the one year prevalence of psychotic disorders among first treatment contact patients. Using logistic regression models, we also determined the association between psychotic disorders and various exposure variables among first treatment contact patients.ResultsIn 2018, 63% (95% CI: 60.2 – 65.1) of all first time contact patients had a psychosis related diagnosis. Among the patients with psychotic disorders, the median age was 29 years (IQR 24 – 36). Most of the patients were male (62.8%) and unemployed (63.1%). After adjusting for patients’ residence, psychotic disorders were found to be more prevalent among the female gender [OR 1.58 (CI1.46-1.72)] and those of Pentecostal faith [OR 1.25 (CI 1.10-1.42)].ConclusionAmong first treatment contact patients in Uganda, there is a large burden of psychotic disorders. The burden was more prevalent among females as well as people of Pentecostal faith who seemed to use their church for faith-based healing. Incidence studies are warranted to determine if this phenomenon is replicated at illness onset.

Minocycline and the risk of acute psychiatric events in adolescence: A self-controlled case series

Background Minocycline has neurological anti-inflammatory properties and has been hypothesised to have antipsychotic effects. Aim The aim of this study was to investigate, using routinely collected United Kingdom primary health care data, whether adolescent men and women are more or less likely to receive an urgent psychiatric referral during treatment for acne with minocycline compared with periods of non-treatment. Method A self-controlled case series using United Kingdom Clinical Practice Research Datalink to calculate the incidence rate ratio of urgent psychiatric referrals for individuals, comparing periods during which minocycline was prescribed with unexposed periods, adjusted for age. Results We found 167 individuals who were at the time exposed to minocycline for a mean of 99 days and who received an urgent psychiatric referral. There was no difference in psychiatric referral risk during periods of exposure compared with periods of non-exposure: incidence rate ratio first 6 weeks of exposure 1.96, 95% confidence interval 0.82–4.71, p=0.132; incidence rate ratio remaining exposure period=1.97, 95% confidence interval 0.86–4.47, p=0.107. Conclusions We found no evidence in support of a protective effect of minocycline against severe psychiatric symptoms in adolescence.

Sexual dysfunction associated with Sertraline and Mirtazapine : A comparative open label study

Introduction: Antidepressants have become one of the most frequently prescribed drugs in the world. One of the most common side effects impairing the long term compliance for antidepressants is sexual dysfunction. Antidepressants like Sertraline have been associated with higher incidence of sexual dysfunction than Mirtazapine. However, there are studies which show that incidence of sexual dysfunction after use of Mirtazapine may be higher than previously expected. The aim of the study was to assess and compare the incidence of sexual dysfunction after therapy with Sertraline and Mirtazapine in a Nepali population. Material and Method: Patients needing antidepressant therapy but with minimal or no sexual dysfunction at baseline were randomly assigned to either Mirtazapine (n=54, 7.5-30 mg) or Sertraline (n=54, 25-100 mg). Various aspects of sexual functioning at baseline were measured with Change in Sexual Functioning Questionnaire (CSFQ) and the same were reassessed at 4 weeks. Results The incidence of sexual dysfunction seen in 42.9% patients in Sertraline group and 23.7% patients in Mirtazapine group. Sertraline showed significantly greater decline in Orgasm scores than Mirtazapine. Conclusion: Psychiatric referral rate and psychiatry morbidity was low. Sertraline caused significant decline in Orgasm aspect of sexual functioning. Although lesser in propensity, Mirtazapine is not free of adverse effect of sexual dysfunction. More studies are need to further confirm these findings.

Capturing acute stress disorder in the trauma population

Acute Stress Disorder (ASD) is classified as a psychiatric diagnosis that was first introduced to the DSM-IV in 1994. It was introduced to describe acute stress reactions that precede Post-Traumatic Stress Disorder (PTSD). ASD usually occurs within the first month after the occurrence of a traumatic event. Early recognition of ASD is crucial from both an early treatment standpoint and avoidance of progressing to PTSD, especially in the trauma population, as late recognition can lead to long-term mental and physical suffering. At this time, there is no protocol for screening of ASD upon admission to a Level I trauma center in the Southeast in the Unites States. Hence, not all trauma patients are assessed for ASD. Often, acute stress is recognized several days after admission, with late referrals to the psychiatric team for psychological evaluation and treatment. This late psychiatric referral often leads to the patient’s inability to participate in physical rehabilitation due to stress and anxiety, thus increasing hospital stay and use of resources. Thus, collaborating between the primary medical team and psychiatry team is essential and facilitates the recovery process for potential acute or long-term psychiatric disorders. To determine if ASD was recognized in the trauma population at a large Level I Trauma Center in the Southeast, and if referrals to psychiatry were initiated in a timely manner, this quality improvement study was developed. The data from this study served to correlate the percentage of patients who screened positive for ASD on admission to a sub-acute trauma floor. A standardized tool called The Stanford Acute Stress Reaction Questionnaire (SASRQ) was used to determine the frequency of ASD in this trauma population. We also ascertained if the trauma nurse practitioners (NPs) had requested a psychiatric referral without the use of the SASRQ tool. Findings included 18 of the 50 trauma patients who had screened positive for ASD (36%). It was found that of those 18 patients who screened positive for ASD, 2 patients received a psychiatric consultation for evaluation and treatment. These findings suggest a needed focus of capturing ASD early in the admission process, using a validated screening tool, along with early psychological intervention to aid in prevention of PTSD post-discharge.

Psychiatric Referral Pattern in a General Hospital

Background: The referral rates of psychiatric patients in Nepal are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a general hospital. Studying the pattern of psychiatric referrals may facilitate the management of the mentally ill in a comprehensive and holistic manner. Materials and methods: The study was conducted at Western Regional Hospital (WRH) over the period of one year. The patients referred from different departments were assessed by the consultant psychiatrists. Result: A total of 816 patients were referred for psychiatric consultation out of which majority was from department of medicine and the most common reason for referral was anxiety disorder. Conclusion: Multi-disciplinary interaction is beneficial to identify the psychiatric morbidity in the patients who attend general hospital.