THE ANONYMOUS PATIENT - CLINICAL CHARACTERISTICS OF PATIENTS UNIDENTIFIED AT PRESENTATION

Objective: The aim of this study was to investigate the characteristic s of patients whose identities are unknown at presentation to psychiat ric services. Method: We retrospectively reviewed 12 years of presenta tions to an emergency psychiatric unit and identified 37 anonymous pre sentations in that period, Cases were assessed with regard to demograp hic data, legal status, reasons for presentation, putative diagnosis a t presentation, eventual documented (ICD-9) diagnosis, previous histor y, duration of anonymity, method of identification and re-occurrence. Results: 0.6% of all patients who presented during the study period we re unidentified for at least 24 hours. Patients were young (mean age 3 3.6 years), Over half were of foreign nationality (53%), The majority were suffering from major psychotic illnesses (86%). When compared wit h all admissions during the study period, schizophrenia and drug-induc ed psychoses were significantly more common in the group unidentified at presentation. Malingering, organic psychiatric disorders and dissoc iative states were not commonly encountered underlying diagnoses, All of our patients were subsequently identified, Successful identificatio n methods included self admission, careful examination of personal bel ongings, careful history taking, liaison with police and recognition b y staff. Patients frequently had a previous psychiatric history (91%). Recurrence was uncommon. Conclusion: The anonymous presentation repre sents a unique challenge to the investigative skills of the psychiatri st. The application of basic strategies enables the successful identif ication of the majority of cases.