Diagnosing the Undiagnosed Psychiatric Patients at Surgeon’s Couch

Abstract

Context:The most difficult problem in clinical surgery and medicine is the accurate evaluation of pain, especially abdominal pain. Many patients of chronic abdominal pain remain undiagnosed when laparotomies failed to reveal abnormalities. It is a difficult decision for the surgeon to decide for operative exploration in the absence of a diagnosis and chronic nature of disease.

Aims and objectives: In this study we have attempted to diagnose such cases of abdominal pain which attend surgical unit and other wise remained undiagnosed and combined surgical and psychiatric approach was tried.

Setting and Design:This study was conducted in department of Surgery and Psychiatry of a Rural Medical College. This is a case-control study.

Methods and Material: We included 150 patients of pain abdomen of which 75 patients were having pain in abdomen of chronic nature with no identifiable cause. A combined Surgical and Psychiatric approach was tried in such cases. One of us (P.B.) who did not know the real diagnosis carried out detailed psychiatric evaluation before surgery (pre-operative) and followed up patients at 6months and 2 years. The ICD-10 was used to diagnose patients with psychiatric illness and the P.G.I Health questionnaire – N2 was used pre and post operatively to test for neuroticism and lie scores.

Statistical analysis used: Statistical analysis was done by using appropriate tools.

Results:Out of these 75 patients in which no abnormality was detected after exploration (Negative laparotomy), 21 had mobile caecum (diagnostic entity doubtful), 19 hysterical neurosis, 18 hypochondriasis, and 17 had depression. These patients were compared with controls (Positive laparotomy). It was interesting to note that negative laparotomy patients had significantly higher multisystem involvement, longer duration of illness, more than 6 (mean) medical opinions,and higher previous surgery, lie & neuroticism scores than controls. After surgery, 23 patients improved, 33 remained same (needing psychiatric intervention), and 19 became worse.

Conclusions:Thus, in conclusion it is more important to know what type of a person the disease has than what disease the person has.