PSYCHIATRIC PATIENTS IN MEDICAL OPDs: A PHYSICIANS DILEMMA

OBJECTIVES: To determine the frequency of patients with underlying psychiatric disorders presenting with unexplained vague physical symptoms to medical outpatient department (OPDs) at Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. METHODS: A total of 1049 consecutive patients were enrolled in this study, st th over a period of 6 months from 1 January 2016 - 30 June, 2016 in MedicalOPD, Department of Medicine Unit II (Ward 6), JPMC, Karachi, Pakistan. Adults of all ages and genders, regardless of socio-economic and educational status, attending medical OPD with unexplained vague physical symptoms and giving informed consent were included in study. Exclusion criteria consisted of patients with frank psychosis and (proven and/or suspected) major organic diseases. RESULTS: Out of 1049 patients aged 14 years and above met our inclusion criteria, out of which 441(42%) were males and 608 (58%) were females. Out of 1049 enrolled patients, main underlying diagnosis were irritable bowel syndrome (n=357; 34%), somatization disorder (26.22%, n=275), depression (19.4%, n=204), hypochondriasis (11.6%, n=122), conversion disorder (6.7%, n=71) and globus hystericus (1.9%, n=20). Majority of the patients (64.5%, n=686) lived in home with income levels less than Rs. 25000. About36.5% (n=383) patients were graduate and 63.5% (n=666) were nongraduates. CONCLUSION: Psychiatric illness constitutes a significant bulk of patients thatcome to medical OPDs with unexplained vague physical symptoms and therefore; be inferred that psychiatric patients prove to be a dilemma for physicians regarding how they should be approached and subsequently handled.