Международный журнал неотложной психической помощи и устойчивости человека

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Aggression and Psychosis in Patients Seeking Emergency Psychiatric Care in New Delhi, India

Harsh Garekar, Meghaa Bhargava, Rohit Verma and Shaily Mina

Background/Context: There is high risk of violence and aggression in the medical emergency care settings (MECS) of which psychiatric services constitute an important part, forming lateral entry points for patients into the mental health care system. Psychosis has been imposed as the predominant cause for majority of aggressive presentation in MECS. There is scarcity of Indian data towards this facet.

Objective(s): The aim of the study is to explore the principal reasons for referral to a psychiatric emergency and explore the disorders most commonly associated with violent and aggressive behavior.

Methodology: This cross sectional descriptive study evaluated consecutive psychiatry referrals from the emergency ward for duration of six months at a tertiary care center. Data was gathered using a semi structured proforma and analyzed by SPSS version 17.0. Diagnosis of schizophrenia or related psychotic disorders (SRPD) and other psychiatric disorders was ascertained via ICD-10.

Result(s): Majority of the overall emergency psychiatry referrals presented with aggression (42%) with no significant gender difference. About 72% of aggressive subjects were diagnosed with psychiatric disorders, of which 28% suffered from SRPD. Delirium and affective disorders constituted 12% and 16% of the aggressive subjects respectively, while diagnosis could not be ascertained in 28% subjects. Of the 462 referred cases, 13.6% subjects were suffering from SRPD. About 85% of these subjects presented with aggressiveness and behavioral disturbance. Apart from 12% previously diagnosed cases of SRPD, 88% of the subjects were new cases.

Conclusion: Aggressive behaviour is the principal presentation in psychiatric emergency services, and schizophrenia & related psychosis contribute a significant proportion of these cases. There is a high rate of previously undiagnosed subjects seeking treatment in emergency, highlighting the role of emergency psychiatric services in not just acute crisis management but also in initiating long term treatment.