Journal of Clinical and Diagnostic Research. 2022 Aug, Vol-16(8): VC06-VC09 6 6 DOI: 10.7860/JCDR/2022/55526.16809 Original Article Psychiatry/Mental Health Section Referral Pattern of Inpatients to Psychiatry Department and the Diagnostic Concordance between the Referral Departments and Psychiatry Team- A Retrospective Study INTRODUCTION Physical illness is shown to have a strong association with psychiatric co-morbidity. Such association complicates the course and outcome of both the conditions [1,2]. In the western population, the prevalence of psychiatric comorbidity among general inpatients varies between 26.5% and 60.0% [2,3]. The prevalence of mental disorders among internal medical inpatients and in acutely ill medical patients was found to be 38.7% and 27.2% respectively [2,3]. According to a study in India, psychiatric morbidity among the inpatients and outpatients referred from other departments was reported to be 31.0-34.5%. Yet, the psychiatry referral rates for inpatients remains very low (0.1-3.6%) [4]. The pattern of referral of inpatients by the physician/surgeon to the psychiatry team also varies among countries. In western countries, among the referred inpatients, the most common psychiatric disorder is major depressive disorder [2] whereas in eastern countries, it is delirium [5]. Delirium stands out as the most common diagnosis among patients referred for psychiatric evaluation in a study conducted in Northern India. The other common diagnostic categories were depressive disorders, alcohol dependence syndrome, adjustment disorder and opiod dependence syndrome [4]. The concordance (41.5-47.4%) between the physician’s/surgeon’s diagnosis and those made by the psychiatrists have been evaluated by very few studies [6,7]. The concordance of diagnosis between physicians/surgeons and the psychiatrists among the elderly patients referred to psychiatric services was evaluated by a study conducted in Japan. The results reported the highest concordance for organic brain syndromes (κ=0.47) and low concordance for depression (κ=0.28) and alcoholism (κ=0.27) [7], whereas, a study from Northern India, showed a better concordance for the diagnosis of substance dependence (κ=0.678) and suicidality (κ=0.655) and very low concordance for depressive discorders and delirium with κ<0.3 [4]. Inadequacy in the necessary skills required in diagnosing psychiatric disorders is a reason for failure of psychiatric referrals. Referral rates and psychiatric diagnosis pattern have been evaluated by several studies in India. But the evaluation of diagnostic coincordance between the physicians/surgeons and the diagnosis made by the psychiatrists has been done by only one study in Northern India. So, the present study aimed to evaluate the referral pattern and diagnostic concordance between physicians/surgeons and the psychiatrists among the inpatient referral in South Indian population. MATERIALS AND METHODS This is a retrospective study conducted in Saveetha Medical College in Chennai, Tamil Nadu, India, after obtaining the approval from the Institutional Review Board and Ethical Committee (IRB No:SMC/IEC/2020/03/340). The study was conducted for a period of nine months with data collection from March 2020 to August 2020 and data analysis from September 2020 to November 2020. All the referrals (n=310) made to the psychiatry team from the various inpatient wards from (January 2019 to December 2019) entered in the psychiatric department referral registry were included in the study. INIYAN SELVAMANI 1 , ASWIN SASIDHARAN 2 , B HARITHA SREE 3 , B MINU REKHA 4 , SUMEDHA DONDAPATI 5 Keywords: Alcohol, Delirium, Depression, Kappa ABSTRACT Introduction: The referral of inpatients to psychiatry team is more in India due to the increase in the morbidity rates of people. The referrals to Psychiatric Department with a specific psychiatric diagnosis are considerably very low. Most often, the diagnosis made by the clinicians doesn’t match with that of the psychiatrist. Physical illness is shown to have a strong association with psychiatric co-morbidity. Such association complicates the course and outcome of both the conditions. Aim: To evaluate the pattern of inpatient referral to the Psychiatric Department and to estimate the diagnostic concordance between the referral and psychiatric team. Materials and Methods: This retrospective study, with prior permission from the Department of psychiatry, included all the inpatient referrals (n=310) to Psychiatry Department by other departments from January 2019 to December 2019. Data collection was done from March 2020 to August 2020 and data analysis from September 2020 to November 2020, in Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India. Data was obtained from a psychiatry referral register and was statistically analysed using Microsoft Excel (MS Office 2013) for percentage, mean and Standard Deviation (SD) for descriptive variables. Diagnostic concordance to assess the reason for referral and diagnostic accuracy in terms of reason of referral and psychiatric diagnosis was analysed using kappa statistics. Results: The most common psychiatric disorder for referral was alcohol dependence syndrome (n=102, 32.9%) followed by depression (n=38, 12.3%) and adjustment disorders (n=34, 10.9 %). Concordance was good for intellectual disorder (κ=1.00), depression (κ=0.969) and alcohol dependence syndrome (κ=0.963). Very low concordance was observed in diagnosing acute confusional state (κ=0.195) and panic disorder (κ =0). Conclusion: Alcohol withdrawal syndrome, adjustment disorder and depression were the most common reasons in referring inpatients to psychiatry. Lower concordance for psychiatric disorders like Acute confusional state and Panic disorder could be explained by inadequate psychiatry exposure and hence be improved by better undergraduate psychiatry training.