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Psychiatric consultation cases are increasing while pool of expertise almost remain same

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Staff Reporter

Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) is the tertiary care psychiatry unit which provides specialized mental health care. It has been serving not only the people in its catchment area but to the entire population of the country.

In 2021, the total number of cases seen during the second lockdown was 340. Majorities (175) of cases were new patients while the rest were old cases (165) who needed follow ups and refills of their prescriptions. Of the total new cases diagnosed, 68 were anxiety disorders, 24 alcohol use disorders, 31 depressions, 4 substance used disorders, 2 psychosis and 1 bipolar, 31 others had medical issues.

While in 2022, a total of 3056 new cases visited psychiatric Outpatient Department (OPD) for psychiatric consultation.
One third (1/3) of these new cases in 2022 were patients with anxiety disorders (total of 915) with 626 female and 289 male.

People suffering from anxiety disorder remain highest in both 2021 and 2022.

Other common psychiatric diagnoses included Alcohol and Substance use disorder, depression, and epilepsies.
891 new cases of children and adolescents visited psychiatric OPD in 2022. The most common age range was 11-18 years of age and Anxiety disorders, substance use disorder and Depression were the common reasons for their consultations.

Autism spectrum disorder, Intellectual disability, anxiety disorder and Attention Deficit Hyperactive disorder were some common reasons for consultation in the age range of 1-10 years old.

A total of 393 patients were admitted in the psychiatry ward in 2022. The most common reason for admission was Alcohol Use disorder and substance use disorder. Psychosis, bipolar affective disorder, and depression were the other common reasons for admission.

Psychiatric services in Bhutan are provided by a multidisciplinary team consisting of Psychiatrists, Counselors, Occupational therapist, Speech and language therapists, Health assistant and Nurses.

As per the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), annual report 2022, “With the establishment of the Pema Center under the Royal Command of Her Majesty the Gyaltsuen, the mental health services in the country are expected to improve. The new Pema Center of 60-bedded will be providing outpatient psychiatric consultations and counseling services, emergency services, treatment and procedure rooms, pharmacy, and inpatient wards, including child and family unit and separate detoxification unit.”

Despite this wide range of professionals in the team, the team still lacks psychiatrists subspecialized in various psychiatric fields, clinical psychologists, social workers, specialized mental health nurses and subspecialized counselors. Nevertheless, the team has been working together in order to provide services as necessary and filling in gaps with the available human resources.

Dr. Bikram Chhetri, a Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) graduate, joined the department as a regular Psychiatrist in July 2022 to increase the department’s human resource pool in the psychiatric domains.

Besides providing clinical care, the Psychiatric department also provides training to the resident doctors, medical interns, clinical counsellors, and nursing students from the Faculty of Nursing and Public Health (FNPH), KGUMSB. Currently there are 2 psychiatry residents training in Faculty of Postgraduates medicine (FoPGM), KGUMSB attached to the department. “We have been getting regular interns for a month-long posting, making them more competent to manage common psychiatric issues”, states the report.

Besides the regular clinical work, the Psychiatrists are also involved in liaising with rehabilitation centers for the treatment of patients with alcohol and drug addiction.

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