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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 27  |  Issue : 3  |  Page : 169-172

Pattern of psychiatric admission in Regional Institute of Medical Sciences (RIMS), Imphal


1 PG Student, RIMS, Imphal, India
2 Registrar, RIMS, Imphal, India
3 Professor and Head, RIMS, Imphal, India
4 Senior Resident, Jawaharlal Nehru Institute of Medical Sciences, Imphal, India

Date of Web Publication19-Feb-2014

Correspondence Address:
Mary Haobam
Department of Psychiatry, RIMS, Imphal - 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.127384

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  Abstract 

Context: Pattern of psychiatric admission in Regional Institute of Medical Sciences (RIMS), Imphal. Aims: To examine the socio-demographic and clinical correlates of patients admitted in psychiatry ward, Regional Institute of Medical Sciences (RIMS), Imphal between April 2010 and March 2012. Settings and Design: It was a retrospective file study conducted in the Department of Psychiatry, RIMS. Materials and Methods: A review of case notes of all patients admitted to the psychiatric ward of the hospital between April 2010 and March 2012 was carried out and information regarding socio-demographic characteristics (e.g. age, gender, domicile, and diagnosis) was recorded on a Proforma designed by the authors. Statistical Analysis Used: Data were analyzed using the Statistical Package for Social Sciences (SPSS) 13 for Windows 7. Cross tabulation, frequency statistics, and chi-square test were used for finding the relationship between variables, and the level of statistical significance was set at 5%. Results: Eight hundred and forty-one cases were admitted and analyzed. Out of these, 65.04% were males and 34.9% were females. The mean age of the patients was 34.68 ± 12.68 years. Majority of the inpatients (30.8%) were from the 25-35 years age group. Alcohol dependence syndrome accounted for majority of the cases (34.01%) in males and dissociative disorder accounted for the maximum cases among the female patients (10.3%). The common psychiatric diagnoses were alcohol dependence syndrome, dissociative disorders, psychosis not otherwise specified, bipolar affective disorder, and depressive disorders. Conclusions: Most of the patients were males, young, and from a rural background. Commonest psychiatric diagnosis for which admission was made in RIMS was alcohol dependence syndrome. In spite of prohibition being in place in the state, the abundance of alcohol-related disorders may have important implications for care and planning in the community.

Keywords: Clinical correlates, Psychiatry admissions, Socio-demographic


How to cite this article:
Haobam M, Senjam G, Ningombam H, Loitongbam N, Mohanty R. Pattern of psychiatric admission in Regional Institute of Medical Sciences (RIMS), Imphal. J Med Soc 2013;27:169-72

How to cite this URL:
Haobam M, Senjam G, Ningombam H, Loitongbam N, Mohanty R. Pattern of psychiatric admission in Regional Institute of Medical Sciences (RIMS), Imphal. J Med Soc [serial online] 2013 [cited 2020 Oct 20];27:169-72. Available from: https://www.jmedsoc.org/text.asp?2013/27/3/169/127384


  Introduction Top


Among the treatment options for psychiatric patients, inpatient treatment is a method employed particularly in such situations where the patient behaves disorganized, presents psychotic features, or the life at home becomes difficult. According to Bobier and Warwick, [1] psychiatric inpatient care is often indicated when a patient can no longer be managed safely at home or as an outpatient, though it may be expensive, resource-intensive, and may cause risk to hospital staff. Consequent to the psychiatric reforms and the emphasis on non-institutional methods of treating psychiatric disorders, attention has shifted toward setting up of psychiatric units in general hospitals. [2]

However, findings on the diagnosis of admitted patients in such hospitals vary. For instance, some studies [3],[4] have reported that schizophrenia was the predominant diagnosis of patients admitted to mental health wards, whereas patients with affective disorders, adjustment disorders, and other anxiety disorders were being admitted to a lesser degree. Another study by Thomson [5] also found depression and anxiety as the most common reason for hospital admission, while schizophrenia and related psychosis ranked next, followed by other diagnoses.

Other factors that have been reported to affect the pattern of admission include gender and age of the patients. For instance, admission rates were reported to be higher for males than females. [5],[6] This gender difference in admission may indicate differences in severity or in presentation to psychiatric services, and may have important implications for preventative services. [6] Hutchinson et al. [6] noted no differences in the age of admitted patients. Thompson et al. [5] reported that admission rates peaked in the age 25-44 years for males and 35-44 years for females.

Hospital utilization denotes the manner in which a certain community makes use of its hospital resources. [7] There are limited numbers of psychiatry beds in India, in general, for psychiatry patients who require prolonged stay at the hospital.

The Regional Institute of Medical Sciences Hospital is located in Imphal, Manipur, a state of North Eastern India with an approximate population of about 25 lakhs and has all major specialties. The Department of Psychiatry is an independent department with facilities for providing psychiatric management to both outdoor and indoor patients and also has de-addiction facilities.


  Materials and Methods Top


The study was conducted at the Department of Psychiatry, Regional Institute of Medical Sciences Hospital. The department is independent with facilities for providing psychiatric management to both outdoor and indoor patients.

The inclusion criteria for this study were:

  1. Patient should fulfill the diagnostic criteria of International Classification of Diseases, 10 th edition (ICD-10). [8]
  2. Chart analysis and case record of the patient should be complete.


A review of case notes of all patients admitted to the psychiatric ward of the hospital between April 2010 and March 2012 was carried out and information regarding socio-demographic characteristics (e.g. age, gender, domicile, and diagnosis) was recorded on a Proforma designed by the authors.

The cases were reassessed using the ICD-10 criteria based on the clinical features documented and clinical diagnoses reassigned where necessary. Data were analyzed using the Statistical Package for Social Sciences (SPSS) 13 for Windows 7. Cross tabulation, frequency statistics, and chi-square test were used for finding the relationship between variables, and the level of statistical significance was set at 5%.


  Results Top


A total of 841 patients were admitted during the period 2010-2012 in review. The mean age ± SD was 34.68 ± 12.68 years, with a range of(11-78 years) as shown in [Table 1]. Most [259 (30.8%)] of the inpatients were in the age group of 25-35 years, followed by 25.4% in the 36-45 years age group. Out of the 841 patients, 710 were Hindus by religion, 69 were Christians, and 62 were Muslims. Most of the patients were from rural areas (71.7%).
Table 1: Age-wise distribution

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Majority (547 out of 841) of the inpatients were males and the remaining 294 were females. The mean age of males was 37.45 ± 11.96 years, while the mean age of females was 29.53 ± 12.37 years as shown in [Table 2].
Table 2: Sex-wise distribution

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Psychiatric diagnosis according to ICD-10 criteria was found to be maximum in the alcohol dependence syndrome (ADS) [286 (34.04%)], followed by dissociative disorder [121 (14.4%)] and then by psychosis not otherwise specified (NOS) and bipolar affective disorder (BPAD) [89 (10.6%) and 69 (8.2%), respectively] as shown in [Figure 1]. Majority of the male inpatients had a diagnosis of ADS [284 out of 286 (99.3%)], followed by other substance use disorders (OSUDS), psychosis NOS, and schizophrenia at 100%, 49.4%, and 64.9%, respectively, whereas among the females, most [97of 121 (80.2%)] had a diagnosis of dissociative disorder followed by BPAD [45 (65.2%)] and psychosis NOS [45 (50.6%)] as shown in [Table 3].
Table 3: Comparing sex with diagnosis

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Figure 1 : Different diagnoses of admitted patients

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  Discussion Top


The male dominance observed in this study was similar to the findings of various studies. Hirsch [9] found that men use psychiatric services more often than females. Likewise, in their Epidemiological Catchment Area (ECA) survey, Shapiro et al. [10] reported that higher proportion of women made mental health visits; but in seeking help, men were more likely to turn to the specialized sector than to the generalist while women used both sectors.

Overall admission rates were higher for males than for females, with maximum admission among males in the 36-45 years age group (30.7%) followed by the 25-35 years age group. Among the females, the maximum admission was in the 11-24 years age group (41.5%) followed by the 25-35 years age group (32.0%). This finding was similar to a British study by Thompson et al. [5]

In an Indian study, the duration of hospital stay was found to be less than 2 weeks. [11] In this study, for majority of the patients, the duration of hospital stay was 1-2 weeks and the median duration of hospital stay was 10 days. This finding is similar to other studies which reported a mean duration of hospital stay to be 9-11 days. [11]

In this study, majority of the patients were admitted for ADS, which was maximal in the male patients. This was followed by dissociative disorder, which was more in the female patients. Psychosis NOS and BPAD followed the above two and both were common in females. The predominance of females in dissociative disorder is a well-known finding in psychiatric epidemiology. [12] Another study reported that BPAD in mania was more in the younger age group and the cases were most likely to be females. [13] One interesting finding is that neurotic disorders like generalized anxiety disorder, phobic disorder, personality disorder, and obsessive and compulsive disorder were much less common compared to other disorders like psychosis NOS and BPAD. This is in no way an indication of low prevalence of these disorders. This appears to be due to the fact that these disorders are treated mostly in the outpatient settings. Since in our study we are focusing mainly on indoor patients, the number of patients with anxiety disorder, phobic disorder, personality disorder, and obsessive and compulsive disorder is less.

There were some limitations in the study. Interpretation of diagnosis patterns must be treated with caution as the cases were diagnosed by different psychiatrists over a 2-year period. Admission rates do not directly represent clinical need or morbidity differences, it represents only the use of existing services. Some of the case files were found to have incomplete data about educational qualification, marital status, socioeconomic class, etc. and, hence, could not be compared.

 
  References Top

1.Bobier C, Warwick M. Factors associated with readmissions to adolescent psychiatric care. Aust N Z J Psychiatry 2005;3:600-6.  Back to cited text no. 1
    
2.Fisher WH, Dorwart RA, Schlesinger M, Epstein S, Davidson H. The role of general hospitals in the privatization of inpatient treatment for serious mental illness. Hosp Community Psychiatry 1992;43:1114-9.  Back to cited text no. 2
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3.Nowels A. A review of the medical records of adolescents psychotic inpatients in a general hospital. Hosp Community Psychiatry 1997;28:903-6.  Back to cited text no. 3
    
4.AbuMadini MS, Rahim SI. Psychiatric admission in a general hospital: Patients profile and patterns of service utilization over a decade. Saudi Med J 2002;23:44-50.  Back to cited text no. 4
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5.Thompson A, Shaw M, Harrison G, Verne J, Ho D, Gunnel D. Patterns of hospital admission for adult psychiatric illness in England: Analysis of hospital episode statistics data. Br J Psychiatry 2004;185:334-41.  Back to cited text no. 5
    
6.Hutchinson G, Ramcharan C, Ghany K. Gender and ethnicity in first admission to a psychiatric unit in Trinidad. West Indian Med J 2003;52:300-3.  Back to cited text no. 6
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7.Sakharhar BM, Editor. Hospital Utilization Statistics. Principles of Hospital Administration and Planning. 1 st ed. New Delhi: Jaypee Brothers; 1998. p. 240-5.  Back to cited text no. 7
    
8.The ICD -10 Classification of mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.  Back to cited text no. 8
    
9.Hirsch SR. Psychiatric beds and resources: Factors influencing bed use and service planning. Report of a working party of the section for social and community Psychiatry of the Royal College of Psychiatrists. London; 1988: Gaskell Psychiatry Series.  Back to cited text no. 9
    
10.Shapiro S, Skinner EA, Kessler LG, Von Korff M, German PS, Tischler GL, et al. Utilization of health and mental health services. Three epidemiologic catchment area sites. Arch Gen Psychiatry 1984;41:971-8.  Back to cited text no. 10
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11.Khanna BC, Wig NN, Varma VK. General hospital psychiatric clinic: An epidemiological study. Indian J Psychiatry1974;16:211-20.  Back to cited text no. 11
    
12.Sar V, Tutkun H, Alyanak B, Bakim B, Baral I. Frequency of dissociative disorders among psychiatric outpatients in Turkey. Compr Psychiatry 2000;41:216-22.   Back to cited text no. 12
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13.Danner S, Fristad MA, Arnold LE, Youngstrom EA, Birmaher B, Horwitz SM, et al. Early-onset bipolar spectrum disorders: Diagnostic issues. Clin Child Fam Psychol Rev 2009;12:271-93.  Back to cited text no. 13
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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