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.
Citation
Masters of Medicine (Psychiatry)Publisher
University of Nairobi School of Medicine