Title:

Neuropsychiatric Profile
Of patients attending a medical OPD of railways
referral Hospital, in New Delhi, (Northern
Railways).

Name of Authors:

Dr. Rama shanker

Sr. D.M.O. (Psych)
Dr.Braham Prakash
MD/NRCH
Dr. A.K Govil
MD (Med)

Name of the Institution:

Northern Railways Central Hospital,
Basant, lane, New Delhi

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Introduction:
Railway Health services provide health care to the
beneficiaries free of cost at three levels.
1. Health Unit (like primary health centers).
2. Divisional Hospitals (1st referral level).
3. Central Hospitals located at each Zonal Headquarters
(2nd referral level) which provide secondary care and to
some extent tertiary care (many of which are outsourced)

In most of the Zonal central hospitals:

• None / One Psychiatrist is available, who is also
entrusted to Manage Headache , Epilepsy,
Movement disorders & work in-

• Medical OPD/Medical wards, managing referred

medical patients of all kinds (of course he/she is
also helped by senior physicians )

• In addition to attending/ managing Core

Psychiatric patients (at OPD level).

A lot of Neuropsychiatric morbidity was observed on

cursory examination in Medical Indoor and in
medical OPD patients, which were not paid due
attention or timely intervention.

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According to various studies:
22% to 45 % of medical/surgical patients
have diagnosable Psychiatric disorders

9% to 45 % patients of Epilepsy have

Psychiatric morbidity

Psychosis seen in 10-15 % of, Up to 40%

depression, Anxiety in 26.9, sleep disorders
in up to 48.7 Parkinsonism/movement
disorder patients,

Up to 31.1 % of emergency admissions

have emotional or Psychological problems.

Long standing arthritis associated with

depressive symptoms.

AIMS and Objectives: Neuropsychiatric

Morbidity level &/or CO-Morbidity in Medical OPD in
a railway general hospital and to make our Non
Psychiatric colleagues aware of the Psychiatric burden.

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Method: The Diagnoses were made clinically
(History/MSE/ physical/Neurological examination and
on investigations according to ICD 10 guideline from
July 2010 to Dec 2010.

Patients details/Diagnoses were entered into

computer in MS Access/Excel spread sheets and the
results were analyzed.

Results:
Total 1000 patients

Type CountPercentage
IHD 41 4.1
63
HTN 6.3
DM type II 59 5.9
44
CVA 4.4
Parkinsonism 28 2.8
APD 23
2.3
30
Hypothyroidism/Hyperthyroidism 3.0
Seizures (Primary +secondary) 95 9.5
Headaches (Migraine +Tension headache) 173 17.3
Joint pains 10 1.0
9
COPD 0.9
51
Fever 5.1
15
Sleep disorders(OSA+Insomnia+parasomnia) 1.5
Depression 200 20.0
Bipolar Mood disorders 45 4.5
132
Anxiety (Phobia+GAD+Panic disorders +Social Phobia) 13.2
12
OCD 1.2
50
Nicotine 5.0
35
Alcohol 3.5
59
Psychosis (Schizophrenia+ delusional disorder) 5.9
Dementia 19 1.9
6
Post Head Injury 0.6
Somatoform disorders 23 2.3
8
Suicidal attempt 0.8

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Co-Morbidity:
A. General medical condition: IHD(Total 41)

Neuropsychiatric conditions Count

Depression 5
Anxiety 13
Insomnia 8
Total 26

B. General medical condition: HTN(Total 63)

Neuropsychiatric conditions Count

Memory disturbances 3
Insomnia 3
MDD 8
Anxiety 11
Seizures 3
Headache 2
Psychosis 4
Dissociative disorders 2
Total 36

C. General medical condition:Hypothyroidism(Total

30)

Neuropsychiatric conditions Count

Anxiety 7
MDD 5
Psychosis 3
Sleep disturbance 2
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Dissociative disorder 2
Seizures 4
Total 23

D. General medical condition: COPD(Total 09)

Neuropsychiatric conditions Count

SUD (smoking) 2
Anxiety 3
Depression 1
Alcohol 1
Bipolar mood disorder 1
Total 08

E. General medical condition: DM II(Total 59)

Neuropsychiatric conditions Count

Anxiety 9
Depression 7
Insomina 2
Neuropsychiatric conditions Count
SUD 2
Dementia 3
Bipolar mood disorder 3
Parkinsonism 1
Psychosis 3
Seizures 3
Headache 3
Total 18

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F. General medical condition: CVA(Total 44)

Neuropsychiatric conditions Count

Dementia 8
Seizures 5
Depression 10
Anxiety 5
Total 28

G. General medical condition: APD(Total 23)

Neuropsychiatric conditions Count

Anxiety 5
Depression 5
Somatoform 4
Total 14

H. General medical condition:Parkinsonism(Total 28)

Neuropsychiatric conditions Count

Depression 5
Anxiety 3
Psychosis 2
Sleep disorder 2
Total 12

I. General medical
condition:Migraine/Headache(Total 173)

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Neuropsychiatric conditions Count
Depression 21
Anxiety 27
Sleep disorders 16
Other Emotional reactions 3
OCD 3
Memory disturbance 3
Dissociative disorder 6
BAD 4
Seizures 7
Total 74

J. General medical condition: Seizures(Total 95)

Neuropsychiatric conditions Count

SUD(Alcohol) 5
BAD 2
Depression 8
MR 5
Dissociatve disorder 5
Anxiety 2
Insomnia 4
Psychosis 4
Total 35

General medical condition: Joint pain/Arthritis(Total

10)

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Anxiety 2
Depression 2
Total 04

Discussions:
Above study suggests significant Psychiatric co-
morbidity with medical patients that may be simply
associated, or cause or effect of medical problems
and needs a separate attention.

Drawing/ Illustrations
Results:

Co-Morbidity:

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