Medical evaluation abnormalities in acute psychotic patients seen at the emergency department, Muhimbili National Hospital, Dar es salaam, Tanzania.

Abstract

Background: Psychosis is defined as a thought disorder characterized by false beliefs (delusions) or perception (hallucinations) that significantly hinder the person’s ability to function. Because there are many life threatening conditions that may manifest with psychosis, it is essential to evaluate these patients for medical conditions. Prior studies have shown varied rates of medical pathology in patients presenting to acute care settings with psychosis. Problem Statement The rate and range of medical pathology in patients presenting with psychosis in our region is unknown and this hinders attempts to develop a systematic diagnostic approach to these patients. Aim of study To determine the proportion of patients presenting to the MNH EMD with acute psychosis who have abnormal findings on a standardized medical screening evaluation. Methods This was a prospective observational study of adult patients presenting to the EMD at MNH with acute psychosis. A standardized evaluation form was used to collect data on demographics, history and physical examination. The study data were entered into an Excel database (Microsoft Corporation, Redmond, WA, USA) and analyzed with SAS (SAS Institute Inc., Cary, NC, USA). Results A total of 252 participants were enrolled; 69% were male and the mean age was 30. Our study showed that history and physical examination findings were not sufficient to rule out serious medical conditions. Laboratory investigations were taken for 206 patients of whom 19% had abnormal lab findings, and two-thirds of these abnormal labs were clinically significant. Overall, 11% of patients tested had clinically significant abnormal lab findings. Conclusion and recommendation The overall rate of underlying laboratory abnormality was 19%, which is higher than previously published rates from high-resource settings(1), and these included a small but significant percentage of patients with potentially life-threatening medical conditions, including hypoglycemia and newly-diagnosed HIV and DKA. Based on our findings, patients presenting with psychosis to an acute care facility in this region should be evaluated with physical examination and laboratory studies to rule out underlying medical illness.