A STUDY OF SOCIO-DEMOGRAPHIC AND DIAGNOSTIC PROFILE OF PATINETS ATTENDENING THE PSYCHIATRIC OUT-PATIENT DEPARTMENT OF NOBEL MEDICAL COLLEGE, BIRATNAGAR

Study on prevalence of psychiatric disorders in Eastern part of Nepal, is relatively understudied subject in Nepal. The present study is undertaken with the aim to study the socio-demographic characteristics and diagnostic profile of patients attending the psychiatry OPD of Nobel Medical College, that provides both outpatient and inpatient services to psychiatric patients residing in eastern part of Nepal and nearby Indian villages. It was a retrospective study where all consecutive patients attending the Psychiatry OPD from 1 May 2011 to 30 April 2012 and fulfilling the diagnostic criteria for Category F of ICD-10 were included in the study. Amongst the total number of 637 patients, cases with Epilepsy (N=44), Headache (N=53), other medical disorders (N=13) and incomplete case record (N=17) were excluded, and the final sample size was comprised of 510 cases (males=214 and females=296). Maximum numbers of patients were in the age-group 16-40 years (N=238, 47%) and were married (N=416, 79.04%). Most of the patients suffered from Neurotic stress-related and somatoform disorders (N=214, 41.96%), followed by Mood (N=168, 32.94%) and Schizophrenia, schizotypal and related disorders (N=56, 10.98%).


Introduction:
The WHO estimate of people with mental disorders to be about 450 million (out of a total of 6 billion), with about 150 million suffering from depression, 25 million from schizophrenia, more than 90 million from alcohol or drug use disorders 2 .The impacts of this disorder are severe, with approximately 1 million people committing suicide annually.There is also an increase in co morbidity of this different conditions 2,3 .The mental disorders thus comprise a wide variety of disorders, some of which may not be acknowledged as ailment by many in the society, but still causing a lot of trouble to the sufferers and affecting the productivity of the persons and obviously of the nation.Moreover, the age group which is occupationally more active seems more affected by the disorders, many of which actually have good prognosis, suggesting the need for early identification and prompt management of these illnesses 3 .Awareness programs involving different cultural, occupational, and social groups of the society will definitely be fruitful.Mental disorders are mostly stigmatized in our communities and this affect the overall care of mental health care users.
Although attempts have been made by our many eminent psychiatrists in the past, the mental health professionals and policy makers in the country still finds difficult to obtain reliable information regarding psychiatric morbidity in the country, both in the community and hospitals.Some of the noticeable studies conducted by K.C.& Shah, (1986) 4 , Nepal et al (1986) 5 , Wright (1987) 6 , Shrestha (1987) 7 and Sharma (1987) 8 , show a similar findings in relation to age wise distribution but in many other aspects they are not conclusive and differ from each other, specially whenever the question of diagnosis is placed forward.All those inconsistencies may be because of the difference in methods and methodology used; the setup, subject enrolled in the study and diagnostic criteria used.Despite of all those inconsistencies their findings are always helpful for both the health care providers and policy makers to formulate a necessary policy and plan of action to encounter the difficulties and to improve the quality of mental health services in the country.Similarly many of available studies in mental health in Nepal mostly describes about the people living in the capital city of Nepal and nearby cities, and their findings may also not likely to be generalized.Therefore, keeping this point in mind, the present study is carried out in a city of Nepal; where from not a single study on epidemiology of mental health is reported in the literature until date.Hence this present study is carried out at psychiatric OPD of Nobel Medical College, Biratnagar, just as an attempt to enrich the available literature in the country in regards to socio-demographic characteristics and diagnostic profile of patients attending the psychiatry outpatient department of a tertiary level hospital in eastern part of Nepal.

Material and Method:
A retrospective study was designed with an aim to describe the socio-demographic characteristics and diagnostic profiles of patients attending the psychiatry outpatient department of Nobel Medical College over a period of one year, from 01 May 2011 to 30 April 2012.The objectives were set to study the age, sex, occupation and diagnostic profile of the patients attending the psychiatric out-patient department of the Nobel Medical College over the period of one year, so that the available information can be used in future to improve the quality of health mental health services that the institute has been delivering to the patients who have been deprived of it for quite long period of time.The subjects for this study were comprised by all those consecutive new patients attending the psychiatric out-patient department over the study period and fulfilling the diagnostic criteria for category F of International Classification of Diseases (ICD-10), 10th revision (WHO, 1992).All other cases with incomplete case records, other than ICD-10 Chapter F diagnoses, chronically debilitating patients, and follow-up cases were excluded from the study.The data required for the purposes of study was collected retrospectively using a self-designed proforma and stored in a personal computer and analyzed with help of SPSS version 11.

Table: 3 Distribution of Patient according occupation
Table 3 shows that out of all 510 subjects enrolled in the study 97 (Male 54; 11%; Female 43; 8%) were students and only 49 were government employed.There were high preponderance of female (N=167; 33%) who were idle and engaged themselves at household activities.The result also shows that only few cases were self-employed and were engaged in their own business (N=66; 13%), without significant differences between gender in this group (Male 19 and female 17).  4 , Wright (1987) 6 , Shrestha (1987) 7 , and Sharma (1987) 8 whose observation shows significant high proportion of patients with diagnosis of epilepsy psychosis and depression, rather neurotic disorders.Sharma (1987) 8 described 42% of the patients in his study to be suffering from depression, 17% from neurosis and 16% from epilepsy.Similarly Shrestha (1987) 7 , reported a vast majority of patients with diagnosis of psychosis (63.7%), which was followed by neurosis (18%) and epilepsy (6%) respectively.
Our findings are also similar to the findings reported by Dube (1970)  9 , and Neki 10 , who observation revealed that near about 44% of the patients, in a community setting in northern part of India, were suffering from neurotic and related disorders which was followed by schizophrenia (9.1%).Similar results have also been reported in literature by many eminent mental health professionals throughout the world (Choo, 1997 11 ; Uys et al, 1995 ,12 ,Patel, 1997 13 , Thom et al, 1997 14 ; and Gureje,2006 15 , but they differ in terms of either methodology or diagnostic profiles.The reasons of the difference may be many, and some of them are the cultural factors, literacy rate in the different areas where the studies were conducted, and the setup e.g.psychiatry OPD of a general hospital, community set up, private clinic, mental hospital etc. Although the present study finds Neurotic, Mood Disorders and Schizophrenia as most common psychiatric disorders amongst the people who have been attending the psychiatric out-patient department of Nobel Medical College Teaching Hospital, there were also a noticeable number of cases who did fulfil the ICD-10 Diagnostic Criteria for organic mental disorders (1.56%), behavioural syndromes associated with physiological disturbances and physical factors (1.56%), disorders of adult personality and behaviour (0.19%), mental retardation (5.09%), disorders of psychological development (0.3%), and behavioural and emotional disorders with onset usually occurring in childhood and adolescence (2.35%).Thus, although the bulk of the patients were suffering from neurotic and affective disorders, the patients suffering from the other disorders were also diagnosed and provided services in the Psychiatry O.P.D. of Nobel medical college, Biratnagar.

Recommendation:
Studies of this nature needs to be regularly conducted.
They may not seem ground-breaking in nature, but help in terms of proper planning with resultant improvement in service delivery.

Limitation of Study:
This study is carried out in a OPD setting in a Tertiary Level Teaching Hospital in eastern part of Nepal.Owing to the different socio and cultural parameters, the findings of this study may not likely to be generalized throughout the country; hence the authors therefore would like to propose a separate large scale community and institutionalized based study so that the data can be well generalized.