Referral patterns for psychiatric consultation in a large general hospital.

Referrals for psychiatric consultation from all inpatient and outpatient departments in a large general hospital were analysed. There were 597 referrals--the combined inpatient and outpatient referral rate was approximately 0.78% and the inpatient rate 1.8%. The most common reasons for referral were parasuicide, depression/symptoms of depression, abnormal behaviour and alcohol abuse. Depressive disorders, drug dependence and neuroses were the most common diagnoses made. Medication was prescribed in 38% of cases and psychotherapy was offered in 18%. In 21% of cases the patient was either managed in his original ward or transferred back to the ward with advice regarding management. In 79% of cases management was within the Department of Psychiatry; many of these patients required concurrent treatment from the referring doctor for a physical disorder. The value of improving the quality and availability of consultation-liaison psychiatry services is discussed.

Suicide in South African Indians.

Biographical and psychiatric factors among South African Indians in Durban and the greater Durban area were investigated in 50 successive suicides so designated by a magistrate at the time of the inquest. Response to a suicide questionnaire and a symptom check-list compiled by the authors were analysed. Information was elicited from the families, relatives and friends of the deceased, or people who had known or treated or had some contact with the deceased. Major depression and alcohol abuse were noted in the vast majority of cases studied. Hanging was the most common method of suicide, closely followed by ingestion of toxic substances. Culturally attributable differences were found between the present sample and those reported in the existing literature. This and other findings are presented and discussed.

Iatrogenesis and suicide in South African Indians.

Psychological profiles were obtained by careful, structured interviewing of those who had been close to 47 consecutive South African Indian suicide victims who had died within the greater Durban area between 1982 and 1984, and whose deaths had been designated as 'suicide' by the magistrate conducting the inquest. Almost 50% of the subjects had been suffering from significant physical illnesses, and 65% were taking medication with the potential to potentiate depression. All were retrospectively diagnosed as having been depressed, as they had shown clear signs and symptoms of this illness, yet none was being treated for depression at the time of his or her death. Warnings that they were considering suicide were given by 68%, but little notice was taken. The implications for medical practice and training are discussed.

Medication as a potential cause of depression.

Many different drugs have been reported to cause depression. The substantive literature is reviewed, with particular attention to antihypertensive and cardiac drugs, oral contraceptives, levodopa and major tranquilizers. The nature of the relationship between physical illness, therapeutic drug use and the potentiation or precipitation of depression is explored.