Introduction
Medical comorbidity is common among chronic psychiatric inpatients. Many risk factors are associated, including psychotropics, nature of the mental illness and behavioral factors. This study was conducted to evaluate the mental diseases pattern, the pattern of medical illnesses and the pattern of psychotropic medications used among chronic psychiatric inpatients at Taif mental hospital, the largest mental hospital in Saudi Arabia.
Methodology
A cross-sectional study was conducted among the chronic psychiatric inpatients, who had been admitted into the hospital for at least one year, with no plan for future discharge, with or without medical condition. The data was collected by direct observation of the patients and the surrounding environment and by chart review.
Results
During the study period there were 465 permanent psychiatric inpatients at the hospital, distributed over 13 wards, 76.8% were males and 23.2% females. The highest percentage of inpatients of both sexes fell within one age group of 41-50 years. Most of the inpatients had been admitted for over 10 years (89.2%), and almost all were Saudis (97.6%). Among the total inpatients, 72.5% were diagnosed as schizophrenics, 20.2% as mentally retarded and 7.3% other psychiatric diagnoses; 91.0% were on antipsychotic medication. Over half of the inpatients (55.5%) had at least one associated medical comorbidity. The highest percentage (95.24%) of medical comorbidity fell within the >70 years age group, while the lowest (40.66%) fell within the 31-40 years age group. At least one medical illness was seen among 51.3% of patients with schizophrenia, 74.5% among patients with mental retardation, and 44.1% among those with other mental illnesses. Among all inpatients, 70.5% had medical comorbidity with known onset of medical illness either before or after mental illness diagnosis, and 29.5% with unknown onset. The pattern of comorbidities among the population of psychiatric inpatients was: heart diseases (37.9%), epilepsy (35.7%), hypertension (19.2%), diabetes mellitus (19.8%), respiratory diseases (18.3%), skin diseases (6.0%), infectious diseases (18.7%), and other medical diseases (15.4%). Some patients had more than one medical illness. Patients with schizophrenia and mental retardation had the highest medical comorbidities. Heart diseases were the highest medical comorbidity among schizophrenics followed by diabetes mellitus, while epilepsy was the highest among patients with other mental illnesses and with mental retardation. Infectious diseases and hypertension were higher among patients with other psychiatric diagnoses. Among the total permanent psychiatric inpatients, 16.5% had associated psychiatric comorbidity; 17.8% among schizophrenics, 2.12% among mentally retarded patients, and 44.1% among other mentally ill patients.
Conclusion
Medical comorbidity was present in a substantial number of psychiatric inpatients in Taif mental hospital than among the general Saudi population. Heart diseases, epilepsy, hypertension, diabetes mellitus, respiratory diseases and infectious diseases represented the main bulk of the medical illnesses. Contributing risk factors were likely the mental illness nature, antipsychotics use, in addition to behavioral risk factors, inactivity in particular. The study findings could be used as the basis for future studies.