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

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 DSMIV (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. This work should be attributed to: The Department of Psychiatry, University of Nairobi and the Africa Mental Health Foundation.