Psychiatric Diagnostic Outcome and its Correlates Among Individuals with Medically Unexplained Symptoms in a Nigerian General Medical Practice Setting

Abstract

Background: The larger proportion of attendees in primary health care settings often presents with  somatic symptoms, which may constitute medically unexplained symptoms (MUS). These symptoms are often related to psychosocial pathology thereby constituting diagnostic nightmare for primary health care physicians. This study aimed to describe psychiatric diagnostic outcome and its correlates among individuals with MUS in a Nigerian based general health care setting.

Methods: All consenting cases of MUS seen over a twelve-month period at a general medical practice  setting by the attending general physicians, made up of 150 individuals out of 1,450 consecutive patients , were referred to psychiatrist. their socio - demographic information using designed  questionnaire was obtained and subsequently clinical interview was done with Schedule for Clinical  Assessments in Neuropsychiatry (SCAN). Similarly, the physical health status of the study participants  was also assessed. Data were analyzed with SPSS version 16 using logistic regression analyses to  determine correlates of psychiatric morbidity among them.

Results: The mean age of individuals with MUS wa s 4 0 . 2 ( ± 1 1 . 5 ) years and  predominantly married females. A total of 120(80%) participants had psychiat r ic diagnoses; wi th  depressive illness (28%) and anxiety disorders 18 (12%) the  commonest, while somatoform disorder was diagnosed among 15(10%) participants. Most of the  subjects diagnosed with psychiatric disorder were younger   [OR=-5.1(-10.3-9.8)], females [OR=4.3(1.8-10.7) ] , presented with longer duration of symptoms [OR=5.9(1.2-10.6)], and co-morbid physical disorders [OR=0.4(0.17-0.9)].

Conclusion: Findings in this study suggest that MUS are commonly encountered in general medical practice and depression with anxiety constitute important psychiatric diagnostic outcomes. Therefore, this study further underscores the need for scaling up psychiatric services in general medical practice. The training of primary health physician on mental health issues and promotion of Consultation-Liaison psychiatric services in primary health care settings are advocated

Keywords: Correlates; Diagnostic outcome; Medically unexplained symptoms; Primary care