Consultation-liason psychiatry in Fiji

To examine and report the characteristics of the patients seen on the consultation-liaison (C-L) psychiatry in the main general hospital in Fiji-Islands.

The socio-demographic and clinical indices of all the patients referred to the C-L psychiatric service between January 1999 and June 2000 were retrieved from the computerized C-L psychiatry register and analyzed. These were compared, in certain aspects, with those of the patients seen in psychiatric hospital located within the same city.

The rate of referral to the C-L service was 0.4% of all hospital admission and outpatient referrals. A major reason for referral was psychiatric comorbidity (80.5%). Other reasons include social problems, neurological conditions such as epilepsy and migraine. About fifty-four percent of the patients were referred to the C-L psychiatric service by internists. The mean age of the patients seen on this service was 31.1 (SD 13.1) years, while those of psychiatric hospital patients were 32.6 (SD14.5) (inpatients) and 33.2 (SD13.9) years (outpatients). A majority of C-L patients were female and of Indian descent, while the psychiatric hospital patients were predominantly males with more indigenous Fijian inpatients but more Indian outpatients. The most common psychiatric disorders in the C-L service were depressive episode/recurrent depressive disorder (29.9%), and neurotic, stress-related and somatoform disorders (25.7%). The most common psychiatric disorders encountered in the psychiatric hospital were schizophrenia/delusional disorders (58.5% for inpatients and 52.7% for outpatients) and bipolar affective disorders (30.6% for inpatients and 27.9% for outpatients).

The most likely person to utilize the C-L service in this population is a young adult female Indian who has been suffering from an internal medical condition, which became complicated by depression, resulting in the attending physician seeking psychiatric opinion. The C-L and psychiatric hospital patients are different in age, gender and racial distributions, and in patterns of psychiatric morbidity. The characteristics of this C-L service place it between what obtained in centres in developing countries and advanced ones.