118 Psychiatric morbidity among physically ill persons in eastern Nepal PM Shyangwa, 1 D Joshi, 2 S Sherchan 2 and KB Thapa 1 1 Department of Psychiatry, B.P. Koirala Institute of Health Sciences, (BPKIHS), Dharan, 2 Mental Hospital, Lagankhel, Patan, Nepal Corresponding author: Dr. Pramod M. Shyangwa, Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal, e-mail: pshyangwa@yahoo.com ABSTRACT This cross-sectional hospital-based study investigated the prevalence and pattern of psychiatric morbidity among 151 physically ill psychiatric-referred cases admitted various departments in BPKIHS. Consecutive referral cases were initially worked up by junior residents and diagnosis/differential diagnosis was made by consultant according to ICD-10 diagnostic guidelines. Of total 151; M: 77 (50.9%) and F: 74 (49.1); Majority 38 (25.1%) of subjects were young with age 15-24 yrs and 95 (62.9%) were from plains. About 21.8% referrals came from internal medicine followed by emergency department, 9 (5.9%). The highest number of cases 48 (31.7%) had neuropsychiatric illnesses and 17.0% had some medical complications resulted from suicide act. Among psychiatric co morbidity, dissociative/conversion disorders were the commonest 26 (17.2%) followed by alcohol use-related disorders 25 (16.5%) and depressive disorder 20 (13.2%). To conclude, the co-occurrence of medical and psychological/psychiatric conditions is common, which demands timely identification and early interventions in order to reduce morbidity and mortality. Keywords: Co morbidity, physical and psychiatric condition, general hospital, Nepal. INTRODUCTION The association between physical and psychiatric conditions is a complex, yet common phenomenon. The increased rate of emotional and psychiatric problems in physically ill population has been consistently documented in several studies. The major reasons for such co-occurrence are: firstly, an overall high prevalence of psychiatric morbidity in general population across the societies. The recent WMH (World Mental Health) and WHO sponsored multicentre, multinational study documented an overall high prevalence of mental illness with the lowest rate in Shanghai, China- 4.3% and the highest at 26.4% in the US. 1 In Nepal, the estimated prevalence rate is 10-15.0% in general population and about 14.0% in the population of Kathmandu Valley. 2 Secondly, physical problem adds up to a risk factor for emotional problem or psychiatric disorders as it may act both as the psychological and the physiological stressor. The prevalence of psychiatric disorder in the hospitalized physically ill people has been observed to a range from 5.0% through more than 50.0%, depending upon the specific illness involved. 3 Certain psychiatric disorders are more common in one medical condition than others. For instance, delirium is found in 15 to 30.0% of hospitalized cases, whereas depression, panic and somatization disorders are 2 to 3 and 10 to 20 times higher in physically ill individuals respectively. Similarly, substance abuse is 3 to 5 times higher in this subgroup than general population. 4 The life time prevalence of a mental disorder in chronically physically ill patients was reported to be at 42.0%- the most common being substance abuse and mood or anxiety disorders compared to 33.0% in those who did not have long-term physical disability. 4 Conversely, people with mental illness put themselves at greater risk to develop physical problem owing to the inherent unfavorable symptom of the illness such as lack of judgment and insight and also due to lack of motivation, energy and so forth. Further, mental illness itself alters bio-physiological status making vulnerable for developing medical illness. Psychoimmunology has convincingly demonstrated that stress and depression significantly impair immunocompetency. 5 Consequently, the co-existence of physical and psychiatric morbidity negatively affects the course and outcome of both the conditions resulting in increased overall burden of disease. For example, the presence of major depression negatively affects the outcome of some illnesses such as myocardial infarction and HIV/AIDS. 6 Despite being quite common, the co-occurring psychiatric/ psychological conditions often go undetected or even at times are ignored. However, their presence engenders various deleterious consequences. Chronic suffering, deterioration of physical and psychiatric condition, morbidity and even mortality has been well documented by careful studies. Timely identification of and intervention to such patients will not only enhance their recovery, prognosis 7 but also will help to avoid unnecessary investigations and wastage of resources. Original Article Nepal Med Coll J 2009; 11(2): 118-122