Retrospective Analysis of Cases Consulted at the Department of Psychiatry in a General Hospital in Guangzhou, China

Special Article - Mental Disorders

Gerontol Geriatr Res. 2021; 7(2): 1053.

Retrospective Analysis of Cases Consulted at the Department of Psychiatry in a General Hospital in Guangzhou, China

Zhang LL¹* and Zhao JP²

¹Department of Psychiatry, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong, China

²Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders, Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China

*Corresponding author: Zhang LL, Department of Psychiatry, Guangzhou First People’s Hospital, the Second Affiliated Hospital of South China University of Technology, 1 Panfu Road, Guangzhou, Guangdong, China

Received: April 16, 2021; Accepted: May 06, 2021; Published: May 13, 2021

Abstract

Objective: To comprehensively analyze cases of psychiatric consultation in a general hospital and provide a primary reference for the development of consultation-liaison psychiatry.

Method: A retrospective study was conducted by analyzing data collected over a two-year period regarding psychiatric consultations from the inpatient registry in a general hospital.

Results: A total of 926 and 774 psychiatric consultations were recorded in 2016 and 2017, respectively. The most common reason for consultation was unexplained somatic symptoms. Consultations based on psychological evaluation, and mental/behavioral disorders due to organic diseases and perioperative stress were significantly higher in 2017 than those in 2016 (P<0.01). Diagnoses of neurotic, stress-related and somatoform disorders were significantly lower in 2017 compared to those in 2016 (269 (34.8%) cases in 2017 vs. 373 (40.3%) cases in 2016; P=0.019). Among specific diagnoses, generalized anxiety disorder was the most common.

Conclusion: Most patients with depressive or anxiety disorders visit a general hospital due to somatic symptoms. It is necessary to train nonpsychiatrists to identify mental disorders efficiently, as well as to extend the comprehensive consultation model to include more clinical departments.

Keywords: Consultation-liaison psychiatry; General Hospital; Mental disorder; Anxiety

Introduction

Mental health problem is a serious issue among medically ill patients in general hospitals. Patients with mental disorder comorbidities show increased morbidity and mortality. If these comorbidities are not recognized and treated, they not only lead to an increased risk of multiple hospital visits and prolonged hospital stay, but also to higher medical expenses and ineffective treatment [1-3]. Due to the importance placed on mental health in China, the National Mental Health Work Plan (2015-2020) specifies that tertiary referral hospitals must include a psychiatric department. Huang et al. conducted a questionnaire-based cross-sectional epidemiological study on the prevalence of mental disorders in China between 2013 and 2015, and reported that anxiety disorders were the most common class of disorders among subjects both in the twelve months preceding the interviews, and in their lifetime [4]. Approximately 50% of the patients with a major depressive disorder or anxiety disorder prefer to visit a general hospital for the first consultation. Furthermore, more than 80% of those patients complaint only about somatic symptoms [5]. Patients with chronic psychical illness, or those in the perioperative period, have increased risks of comorbidities such as anxiety or depression [6-8].

Psychiatric consultation-liaison services play an important role in the diagnosis and treatment of mental comorbidities and psychological burdens in patients [9]. However, this model cannot be implemented for all patients with mental health concerns because of the high prevalence of mental comorbidities. Moreover, the inability to identify cases of mental disorders, or misdiagnose them, in non-psychiatry departments is common, and eventually results in treatment delay and waste of medical resources [10]. Simon et al. reported that the healthcare service costs of patients with diabetes and depression were twice as much as those of patients with only diabetes [11]. Currently, there are few reports regarding intrahospital consultation of cases to psychiatry departments in general hospitals in China, and data regarding the working conditions in these departments are also insufficient. We examined all cases of consultations to psychiatrists in a tertiary referral hospital between 2016 and 2017, with the aim of classifying those using different criteria and providing a primary reference for the development of Consultation-Liaison Psychiatry (CLP) in China.

Subjects and Methods

Ethics

The study protocol was approved by the ethics committee of Guangzhou First People’s Hospital. All patients provided written informed consent for their participation.

Study design and participation

Intra-hospital consultation was defined as a clinical department or medico-technical department (henceforth referred to as “principal department”) consulting a psychiatrist or the psychiatry department within the same hospital (henceforth referred to as “consultant psychiatrist”) to provide guidance regarding diagnosis and treatment of psychiatric disorders within the scope of their practice. Consultations that were accepted within 24 hours were considered in the study. Cases where the consultant psychiatrist arrived by the bed of the patient within 10 minutes of referral were classified as urgent consultations. Special cases were those that were referred directly to the chief of the psychiatry department for guidance.

We carried out this retrospective study by extracting information from the inpatient registry. New cases referred to the department of psychiatry in our hospital between 1 January 2016 and 31 December 2017 were included in the study. All consultation cases were registered in the patient record system. Repeated consultations for the same patient were not included in the study. Thus, we counted the total number of new consultation cases instead of the total number of visits to the department of psychiatry.

Statistical analysis

All statistical analyses were conducted using IBM SPSS software, version 22.0 (IBM Corp., Armonk, N.Y., USA). Two-tailed statistical tests were conducted, with a P value <0.05 considered as statistically significant. Continuous variables were described using summary statistics such as Mean ± Standard Deviation (SD), and their normality was assessed by the Shapiro-Wilk normality test. Categorical variables were described using frequencies and percentages. Data were compared using the t-test or Χ² test as appropriate.

Results

General information

Between 1 January 2016 and 31 December 2017, 1700 new cases of intra-hospital psychiatric consultations were registered. The total number of inpatients, excluding repeated hospitalizations, over the same period were 53627 and 55249 in 2016 and 2017, respectively. Out of those inpatients, 926 (1.7%) patients in 2016, and 774 (1.4%) patients in 2017 were referred for psychiatric consultation.

In 2016, 355 out of the 926 patients (38.3%) referred for psychiatric consultation were male and 571 (61.7%) patients were female. The age range was 8–97 years with a mean of 62.72±18.21 years. Further, 30 (3.2%) cases were urgent consultations and 896 (96.8%) were general consultations; A history of mental disorders was found in 365 (39.4%) cases.

In 2017, 294 out 774 patients (38.0%) were male and 480 patients (62.0%) were female. The age range was 895 years with a mean of 61.16±18.27 years. There were 22 (2.8%) urgent consultations and 752 (97.2%) general consultations. A history of mental disorders was found in 198 (25.6%) cases, which was significantly lower than that seen in 2016 (P<0.001) (Table 1). No significant differences were observed between the two groups for other variables (P>0.05) (Table 1).