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    Title:

    Neuropsychiatric ProfileOf patients attending a medical OPD of railways

    referral Hospital, in New Delhi, (Northern

    Railways).

    Name of Authors:

    Dr. Rama shanker

    Sr. D.M.O. (Psych)Dr.Braham Prakash

    MD/NRCH

    Dr. A.K GovilMD (Med)

    Name of the Institution: Northern Railways Central Hospital,

    Basant, lane, New Delhi

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    Introduction:

    Railway Health services provide health care to thebeneficiaries free of cost at three levels.

    1. Health Unit (like primary health centers).

    2. Divisional Hospitals (1st referral level).

    3. Central Hospitals located at each Zonal Headquarters

    (2nd referral level) which provide secondary care and to

    some extent tertiary care (many of which are outsourced)

    In most of the Zonal central hospitals:

    None / One Psychiatrist is available, who is also

    entrusted to Manage Headache , Epilepsy,Movement disorders & work in-

    Medical OPD/Medical wards, managing referred

    medical patients of all kinds (of course he/she is

    also helped by senior physicians )

    In addition to attending/ managing Core

    Psychiatric patients (at OPD level).

    A lot of Neuropsychiatric morbidity was observed on

    cursory examination in Medical Indoor and inmedical OPD patients, which were not paid due

    attention or timely intervention.

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    According to various studies:

    22% to 45 % of medical/surgical patientshave diagnosable Psychiatric disorders

    9% to 45 % patients of Epilepsy have

    Psychiatric morbidity

    Psychosis seen in 10-15 % of, Up to 40%depression, Anxiety in 26.9, sleep disorders

    in up to 48.7 Parkinsonism/movement

    disorder patients,

    Up to 31.1 % of emergency admissions

    have emotional or Psychological problems.

    Long standing arthritis associated with

    depressive symptoms.

    AIMS and Objectives: NeuropsychiatricMorbidity level &/or CO-Morbidity in Medical OPD in

    a railway general hospital and to make our Non

    Psychiatric colleagues aware of the Psychiatric burden.

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    Method: The Diagnoses were made clinically(History/MSE/ physical/Neurological examination and

    on investigations according to ICD 10 guideline from

    July 2010 to Dec 2010.

    Patients details/Diagnoses were entered intocomputer in MS Access/Excel spread sheets and the

    results were analyzed.

    Results:Total 1000 patients

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    Type CountPercentageIHD

    41 4.1

    HTN63

    6.3

    DM type II 59 5.9

    CVA44

    4.4

    Parkinsonism 28 2.8APD 23

    2.3

    Hypothyroidism/Hyperthyroidism30

    3.0

    Seizures (Primary +secondary) 95 9.5

    Headaches (Migraine +Tension headache) 173 17.3

    Joint pains 10 1.0

    COPD9

    0.9

    Fever51

    5.1

    Sleep disorders(OSA+Insomnia+parasomnia)15

    1.5

    Depression 200 20.0

    Bipolar Mood disorders 45 4.5

    Anxiety (Phobia+GAD+Panic disorders +Social Phobia)132

    13.2

    OCD12

    1.2

    Nicotine50

    5.0

    Alcohol35

    3.5

    Psychosis (Schizophrenia+ delusional disorder)59

    5.9

    Dementia 19 1.9

    Post Head Injury6

    0.6

    Somatoform disorders 23 2.3

    Suicidal attempt

    80.8

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    Co-Morbidity:A. General medical condition: IHD(Total 41)

    Neuropsychiatric conditions Count

    Depression 5

    Anxiety 13

    Insomnia 8

    Total 26

    B. General medical condition: HTN(Total 63)

    Neuropsychiatric conditions Count

    Memory disturbances 3

    Insomnia 3

    MDD 8

    Anxiety 11

    Seizures 3Headache 2

    Psychosis 4

    Dissociative disorders 2

    Total 36

    C. General medical condition:Hypothyroidism(Total30)

    Neuropsychiatric conditions Count

    Anxiety 7

    MDD 5

    Psychosis 3

    Sleep disturbance 2

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    Dissociative disorder 2

    Seizures 4

    Total 23

    D. General medical condition: COPD(Total 09)

    Neuropsychiatric conditions Count

    SUD (smoking) 2

    Anxiety 3

    Depression 1Alcohol 1

    Bipolar mood disorder 1

    Total 08

    E. General medical condition: DM II(Total 59)

    Neuropsychiatric conditions Count

    Anxiety 9

    Depression 7

    Insomina 2

    Neuropsychiatric conditions Count

    SUD 2

    Dementia 3Bipolar mood disorder 3

    Parkinsonism 1

    Psychosis 3

    Seizures 3

    Headache 3

    Total 18

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    F. General medical condition: CVA(Total 44)

    Neuropsychiatric conditions CountDementia 8

    Seizures 5

    Depression 10

    Anxiety 5

    Total 28

    G. General medical condition: APD(Total 23)

    Neuropsychiatric conditions Count

    Anxiety 5

    Depression 5

    Somatoform 4

    Total 14

    H. General medical condition:Parkinsonism(Total 28)

    Neuropsychiatric conditions Count

    Depression 5

    Anxiety 3

    Psychosis 2

    Sleep disorder 2

    Total 12

    I. General medical

    condition:Migraine/Headache(Total 173)

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    Neuropsychiatric conditions Count

    Depression 21

    Anxiety 27

    Sleep disorders 16

    Other Emotional reactions 3

    OCD 3

    Memory disturbance 3

    Dissociative disorder 6

    BAD 4

    Seizures 7Total 74

    J. General medical condition: Seizures(Total 95)

    Neuropsychiatric conditions Count

    SUD(Alcohol) 5BAD 2

    Depression 8

    MR 5

    Dissociatve disorder 5

    Anxiety 2

    Insomnia 4Psychosis 4

    Total 35

    General medical condition: Joint pain/Arthritis(Total

    10)

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    Anxiety 2

    Depression 2

    Total 04

    Discussions:Above study suggests significant Psychiatric co-

    morbidity with medical patients that may be simply

    associated, or cause or effect of medical problemsand needs a separate attention.

    Drawing/ Illustrations

    Results:

    Co-Morbidity:

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