Outcome of a working diagnosis of “psychosis” in relation to DSM-IV diagnostic criteria in a Kenyan in-patient cohort at Mathari hospital, Nairobi

D M Ndetei, L I Khasakhala, F A Ongecha, V Mutiso, D A Kokonya

Abstract
Background: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated, a clinical diagnosis of psychosis is usually entertained.

Aim: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of “psychosis” at Mathari Psychiatric Hospital, Nairobi, Kenya.
Study Design: Descriptive cross-sectional quantitative study.

Method: A total of 138 patients with a working diagnosis of “psychosis” on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5.

Results: Nearly three quarters (72.5%) of the patients were male, 68.5% were aged between 20 and 34 years and 63.7% reported that they were single. Nearly half (49.2%) had attained up to 12 years of formal education and 90% were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia, bipolar disorder, substance abuse, depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders.

Conclusion: “Psychosis” as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was “psychosis” met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just “psychosis” are made and appropriate management initiated as early as possible.