Main Article Content
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, over a period of 6 months from 1st January 2016 - 30th June, 2016 in Medical OPD, 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=75), 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. About 36.5% (n=383) patients were graduate and 63.5% (n=666) were non-graduates.
CONCLUSION: Psychiatric illness constitutes a significant bulk of patients that come 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.KEY WORDS: Irritable Bowel Syndrome (IBS) (MeSH), Somatization Disorder (Non-MeSH), Depression (MeSH), Hypochondriasis (MeSH), Conversion Disorder (MeSH), Globus Hystericus (Non-MeSH).
Work published in KMUJ is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
1. Srinivasan TN, Suresh TR. Nonspecific and specific symptoms in non-psychotic morbidity. Indian J Psychiatry 1990;32(1):77-82.
2. Van Hemert AM, Hengeveld MW, Bolk JH, Rooijmans HG, Vandenbroucke JP. Psychiatric disorders in relation to medical illnesses among patients of a general inpatient clinic. Psychol Med 1993;23(1):167-73.
3. Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of depression in a large urban South Indian population -- the Chennai Urban Rural Epidemiology Study (CURES-70). PLoS One 2009;4(9):e7185.
4. Mitchell S, Olaleye O, Weller M. Current trends in the diagnosis and management of globus pharyngeus. Int J Otolaryngol Head Neck Surg 2012;1(3):57-62.
5. Pearson SD, Katzelnick DJ, Simon GE, Manning WG, Helstad CP, Henk HJ. Depression among high utilizers of medical care. J Gen Intern Med. 1999;14(8):461–8.
6. Goldberg D, Privett M, Ustun B, Simon G, Linden M. The effects of detection and treatment on the outcome of major depression in primary care: A naturalistic study in 15 cities. Br J Gen Pract 1998;48(437):1840–4.
7. Goldberg DP, Huxley P. Common mental disorders. A bio-social model. London, Tavistock/Routledge, 1992.
8. Brenner DM1, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastreoenterol 2009;104(4):1033-49.
9. North CS, Alpers DH, Thompson SJ, Spitznagel EL. Gastrointestinal symptoms and psychiatric disorders in the general population. Findings from NIMH Epidemiologic Catchment Area Project. Dig Dis Sci 1996;41(4):633–40.
10. Diagnostic & Statistical Manual of Mental Disorders, 5th ed. DSM-5. American Psychiatric Association (APA), 2013.
11. Olfson M, Shea S, Feder A, Fuentes M, Nomura Y, Gameroff M, et al. Prevalence of anxiety, depression and substance use disorders in an urban general medicine practice. Arch Fam Med 2000;9(9):876-83.
12. Owens C, Dein S. Conversion disorder: the modern hysteria. Advances in Psychiatric Treatment Feb 2006;12(2):152-157.
13. Feinstein A. Conversion disorder: advances in our understanding. Can Med Assoc J 2011;183(8):915-920. doi:10.1503/cmaj.110490.
14. Schulberg HC, Burns BJ. Mental Disorders in Primary Care-Epidemiological Diagnostic and treatment research directions. Gen Hosp Psychiatry 1998;10(2):79-87.
15. Borus JF, Howes MJ, Devins NP, Rosenberg R, Livingston WW. Primary health care providers’ recognition and diagnosis of mental disorders in their patients. Gen Hosp Psychiatry 1988;10(5):317–21.
16. Bagadia VN, Ayyar KS, Lakdawala PD, Sheth SM, Acharya VN, Pradhan PV. Psychiatric morbidity among patients attending medical out patients department. Indian J Psychiatry 1986;28(2):139–44.
17. Ormel J, Koeter MW, Van den Brink W, Van de Willige G. Recognition, Management and course of anxiety and depression in General Practice. Arch Gen Psychiatry 1991;48(8):700-6.
18. Shepherd M, Cooper B, Brown AC, Kalton G. Psychiatric illness in general practice. Oxford, Oxford University Press, 1966.
19. Editorial: Welcome clinical leadership at NICE. Lancet 2008;372(9639):601. doi: 10.1016/S0140-6736(08)61249-0.
20. Kessler RC1, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51(1):8–19.
21. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self report version of PRIME-MD: The PHQ Primary Care Study. J Am Med Assoc 1999;282(18):1737–44.
22. Nandi DN, Banerjee G, Boral GC, Ganguli H, Ajmany(Sachdev) S, Ghosh A, et al. Socio economic status and prevalence of mental disorders in urban rural communities in India. Acta Psychiatr Scand. 1979;59(3):276–93.
23. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care 2004;42(12):1194–201.
24. Kochhar PH, Rajadhyaksha SS, Suvarna VR. Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depression disorder in Indian patients. J Postgrad Med 2007;53(2):102–07.
25. Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in primary care practice. Arch Gen Psychiatry 1988;45(12):1100–06.
26. Kohli C, Kishore J, Agarwal P, Singh SV. Prevalence of unrecognised depression among outpatient department attendees of a rural hospital in Delhi, India. J Clin Diagn Res 2013 Sep;7(9):1921-5. Doi: 10.7860/JCDR/2013/6449.3358.
27. Kulkarni V, Chinnakali P, Kanchan T, Rao A, Shenoy M, Papanna MK. Psychiatric co-morbidities among patients with select non-communicable diseases in a Coastal City of South India. Int J Prev Med 2014;5(9):1139-45.