Pattern of Referral of Patients with COVID-19 for Psychiatric Consultation: Experience at a Multidisciplinary Hospital in Karachi, Pakistan.

Aisha Noorullah, Bilal Ahmed, Muhammad Yusuf Hafiz, Shahina Pirani, Murad Khan
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Abstract

Objective: To determine referral patterns for psychiatric consultations among COVID-19 patients encompassing both the in-patient and Emergency Department of a multidisciplinary hospital in Karachi, Pakistan.

Study design: A retrospective chart review. Place and Duration of the Study: The Aga Khan University Hospital, Karachi, Pakistan, from March 2020 to December 2021.

Methodology: The research team collected pertinent information from medical records using a standardised proforma, which encompassed data from physicians' notes, nurses' notes, assessment forms, and discharge summaries. The data were analysed using descriptive and inferential statistics.

Results: This study examined 233 psychiatric referrals, with 67% male patients (n = 156) and 57.1% (n = 133) aged above 60 years. The primary psychiatric diagnosis was delirium (47.1%, n = 105), followed by adjustment disorders (10.8%, n = 27) and mood disorders (11.7%, n = 25). The main symptoms leading to consultation were agitation/confusion (45%, n = 106) and psychotropic adjustment (18%, n = 41). Clinical outcomes, including mortality, were associated with agitation/confusion (p = 0.001), delirium (p = 0.001), older age (p = 0.003), and longer length of stay (p = 0.001). Patients aged 61 years and above exhibited frequent agitation/confusion (p = 0.002) and delirium (p = 0.001). Longer stays correlated with agitation/confusion (p = 0.022), and a one-month hospital stay showed an association with delirium (p = 0.050).

Conclusion: This study highlights the crucial role of consultation-liaison psychiatric services in addressing the psychological issues in COVID-19 patients. The significance of delirium and its high mortality risk underscores the need for focused research and integration of mental health care into pandemic responses for comprehensive patient care.

Key words: Referrals, Psychiatric consultations, Hospitalised patients, COVID-19, Pakistan, Consultation-liaison services.

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COVID-19患者转诊精神科会诊模式:巴基斯坦卡拉奇一家多学科医院的经验
目的:确定巴基斯坦卡拉奇一家多学科医院的COVID-19患者的精神会诊转诊模式,包括住院部和急诊科。研究设计:回顾性图表回顾。研究地点和时间:2020年3月至2021年12月,在巴基斯坦卡拉奇的阿迦汗大学医院。方法:研究小组使用标准化形式从医疗记录中收集相关信息,其中包括来自医生笔记、护士笔记、评估表和出院摘要的数据。使用描述性和推断性统计对数据进行分析。结果:本研究检查了233例精神科转诊患者,其中男性患者占67% (n = 156), 60岁以上患者占57.1% (n = 133)。主要精神病学诊断为谵妄(47.1%,n = 105),其次为适应障碍(10.8%,n = 27)和心境障碍(11.7%,n = 25)。导致就诊的主要症状是躁动/精神错乱(45%,n = 106)和精神药物调整(18%,n = 41)。临床结果,包括死亡率,与躁动/精神错乱(p = 0.001)、谵妄(p = 0.001)、年龄较大(p = 0.003)和住院时间较长(p = 0.001)相关。61岁及以上患者表现为频繁的躁动/精神错乱(p = 0.002)和谵妄(p = 0.001)。住院时间较长与躁动/精神错乱相关(p = 0.022),住院一个月与谵妄相关(p = 0.050)。结论:本研究突出了精神科会诊联络服务在解决新冠肺炎患者心理问题中的重要作用。谵妄的重要性及其高死亡率风险强调了有必要进行重点研究,并将精神卫生保健纳入流行病应对措施,以提供全面的患者护理。关键词:转诊,精神科会诊,住院患者,COVID-19,巴基斯坦,会诊联络服务
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