Abstract

The motives for admission to the psychiatric department of Victoria Hospital over the whole year 1996 were retrospectively examined. There were 539 admissions corresponding to 352 different patients. Alcohol related mental and behavioral disorders accounted for 38% of the total number of admissions and 35% of the total number of patients, schizophrenia and related psychoses for 32% and 29%, and other mental and behavioral disorders for 30% and 36% respectively. A majority of patients with alcohol related mental and behavioral disorders presented with withdrawal state (54%). These results highlight the magnitude of alcohol related disorders as a cause of admission to our psychiatric department. (SMDJ, 1999;6;16-17.)

Method

The cause of admission was retrospectively expressed as a diagnosis according to the ICD-10 of the WHO (1) and based on the admissions register and case notes of the patients. In case of multiple psychiatric diagnoses, only the diagnosis responsible for the admission was considered in the analyses. The following diagnostic categories were considered:

Alcohol related mental and behavioral disorders relate to patients with alcohol withdrawal syndrome (alcohol dependent patients presenting clinical withdrawal state); alcohol dependence syndrome (patients with physical or psychological dependence, generally admitted for rehabilitation purposes or presenting with physical or psychiatric complaints such as insomnia, anxiety, depressive states, or for social reasons); alcohol induced psychosis (psychotic conditions which occur in patients with a history of long standing alcohol consumption, which cannot be classified under schizophrenia and related psychoses); acute intoxication (behavioral disorders due to acute alcoholic intoxication with or without dependence on alcohol and other psychiatric disorder).

Mental and behavioral disorders due to psychoactive substance abuse (other than alcohol) relate to patients with clinical syndromes due to drug abuse, such as drug dependence, intoxication, withdrawal state and psychotic states. Almost all patients in this group were users of cannabis. Other drugs were occasionally encountered, especially in visitors.

Disorders of adult personality and behavior or social problems relate to patients with acute social crisis, family conflict and lack of social accommodation. Some of these patients were suffering from personality and behavioral disorders.

Organic mental disorders relate to dementia and other disorders secondary to organic brain injury due to causes other than alcohol.

Medical disorders relate to patients admitted for medical reasons other than psychiatric.

Results

Diagnoses of admission are reported on Table 1. Alcohol related mental and behavioral disorders accounted for 38.0% of the total number of admissions and 35.2% of the total number of patients. The number of admissions per 1,000 population were apparently lower in some districts of south Mahé, which are both less populated and more remote from Victoria hospital (e.g. Takamaka, Port Glaud), than in other districts of the country (Table 2). The number of admissions (particularly due to alcohol related disorders) categorized by district could not reflect the true picture since a proportion of patients from south Mahé might be admitted to Anse-Royale Hospital for treatment.

 
 

Table 1. Distribution of admissions by categories of disorders
	Admissions			Patients
	No	%		No	%
Alcohol related disorders [F10]	205	38.0		124	35.2
Schizophrenia and related psychoses [F20-29]	170	31.5		102	29.0
Mood affective disorders  [F30-39]	50	9.3		39	11.1
Disorders of adult personality and behavior / social problems	42	7.8		29	8.2
Drug abuse [F12]	20	3.7		15	4.3
Mental retardation [F70-79]	15	2.8		09	2.5
Neurotic disorders [F40-48]	11	2.0		09	2.5
Attempted suicide	10	1.9		10	2.8
Medical problem	10	1.9		10	2.8
Organic mental disorders   [F00-09]	06	1.1		05	1.4
Total	593	100		352	100

 

The distribution of admissions by major syndrome appears in Table 3. A majority of patients with alcohol related disorders presented with withdrawal symptoms (Table 4). Fifty per cent and 77% of admissions due to alcohol related mental and behavioral disorders concerned patients aged 30-39 and 30-49 years respectively. The total number of 205 admissions due to alcohol related disorders related to 124 patients, 108 males and 16 females. This gave a male to female ratio of 7:1. Another salient observation was that among all the patients admitted with alcohol related problems 51.5% were unemployed at the time of admission.

 
 

Table 2. Admissions* with alcohol-related disorders by district
	Population	Adm-issions	Admissions per 1,000 pop.	95% CI
English River	17,979	68	3.8	0.2-4.7
Anse aux Pins	7,504	45	6.0	4.3-8.0
Corgate Estate	4,596	25	5.4	3.5-8.0
Les Mamelles	9,657	17	1.8	1.0-2.8
Anse Royale	4,562	14	3.0	1.6-5.4
Beau-Vallon	6,336	8	1.30	0.5-5.4
Anse Boileau	3,763	8	2.1	0.1-5.7
Glacis	2,571	7	2.7	0.4-3.9
Beoliere	2,271	6	2.6	1.0-5.9
Baie Lazare	2,612	4	1.5	0.4-3.9
Takamaka	2,322	1	0.3	0-2.4
Port-Glaud	1,787	0	0.0	0-2.1
Total			3.1	2.6-3.5

*Different admissions may include new and recurrent admissions of same patients.

Discussion

Excessive alcohol consumption is known to cause a variety of physical, psychological and socio-economic disabilities. It is generally felt that alcohol related admissions account for a significant proportion of all hospital admissions, not only to the psychiatric sector but also to other hospital departments. This study shows that this proportion was high in Seychelles. It is documented that in the United Kingdom psychiatric admissions for alcohol related problems account for 10% of all psychiatric admissions. In France and Germany the figure is around 30% (1).

The global incidence of admissions due to alcohol related disorder was 3 per 1000 population per year. The incidence for different districts varied from 0 to 6 per 1000. Apparent lower proportions of alcohol related problems in some districts of South or West Mahé may relate to a random effect (as confidence intervals of most estimates overlap), correspond to actually lower percentage of people drinking in excess in these areas, reflect the fact that persons in districts closer to the Hospital tend to use more hospital services, or a combination of these factors.

It is to be noted that over 75% of total alcohol related admissions were aged 30-50 years, i.e. an age group which consists of an employed and productive population. The

Table 3. Admissions by major syndrome, sex and age
	Admission			Sex					Age
	No	%		Male (No)	Female (No)		Ratio		<45	>45	Ratio
Alcohol related disorder	205	38.0		172		33	5.2		156	49	3.2
Psychotic disorder	170	31.5		101		69	1.5		149	21	7.1
Mood affective disorder	50	9.3		14		36	0.4		39	11	3.5
Behavioral/social problem	42	7.8		17		25	0.7		38	4	9.5
Drug abuse	20	3.7		20		0	-		20	0	-
Mental retardation	15	2.8		9		6	1.5		12	3	4.0
Neurotic disorder	11	2.0		2		9	0.2		11	0	-
Attempted suicide	10	1.9		3		7	0.4		10	0	-
Medical problem	10	1.9		5		5	1.0		9	1	9.0
Organic mental disorder	6	1.1		4		2	2.0		1	5	0.2
Total	539	100.0		347		192	1.8		445	94	4.7

unemployment rate of 51.5% among patients admitted with alcohol related problems could relate to heavy drinkers losing their employment due to unsatisfactory work records or heavy drinkers not seeking a job due to poor self-esteem.

The fact that alcohol related admissions are frequent emphasizes the need to identify and implement measures to reduce excess drinking in the country. This could be achieved by identifying and treating the problem drinkers and those with alcohol related disabilities and by implementing measures to reduce the alcohol consumption in the population. There is indeed a strong correlation between average annual consumption in a society and the frequency of persons with alcohol related problems so that the proportion of alcohol abusers is largely determined by the average consumption of that population (2). High alcohol consumption is indeed no recent problem in Seychelles and is perhaps at least as high as in England or France (3,4) and organic pathologies such as alcoholic cardiomyopathy have been found to be frequent among males (5).

Psychiatric services deal generally only with those patients who have been admitted to the unit due to acute problems. The high number of admissions for such acute conditions could be reduced if further measures were taken to curb drinking in the population and reduce the number of heavy drinkers. Such measures can include further regulatory measures related to production, availability and the use of alcoholic beverages and to establish institutions for the long-term rehabilitation of alcoholics.
 
 

Table-4. Age and sex distribution (M/F) of admissions due to alcohol related mental and behavioral disorders
Age	Alcohol withdrawal syndrome	Alcohol dependence syndrome	Alcohol induced psychosis	Acute alcohol intoxication	Total	% all admi-ssions
20-29	11 / 0	4 / 4	2 / 0	4 / 1	21 / 2	11.2
30-39	42 / 11	23 / 11	8 / 1	4 / 3	77 / 26	50.2
40-49	32 / 1	13 / 0	7 / 1	0 / 0	52 / 2	26.3
50-59	12 / 0	8 / 0	0 / 1	0 / 0	20 / 1	10.3
60-69	1 / 1	0 / 1	1 / 0	0 / 0	2 / 2	2.0
Total	98 / 13	48 / 13	18 / 13	8 / 4	172 / 33	100
Overall	111	61	21	12	205	100

 
 

References

1. World Health Organization ICD-10 Classification of mental and behavioral disorders, World Health Organization, 1993.
2. Gelder M, Gath D, Mayou R. Oxford Textbook of Psychiatry, 1993.
3. International statistics on alcoholic beverages: production, trade and consumption in 1950-1972. Finnish Foundation for Alcohol Studies. 1977;27, 209-222.
4. Perdrix J, Bovet P, Larue D et al. Patterns of alcohol consumption. Alcohol & alcoholism (in press).
5. Pinn G, Bovet P. Alcohol-related cardiomyopathy in the Seychelles. Medical Journal of Australia 1991;155, 529-532.