The study was conducted at the psychiatry department of the Lieutenant-Colonel Mamadou Diouf Regional Hospital Center of Saint-Louis, an outpatient unit annexed to the hospital comprising two consultation offices, one nursing office, an observation room and a waiting area. Staffing consisted of one professor of psychiatry (head of department), one nurse, and two residents in psychiatry. The study period extended over six months, from 2 January to 30 June 2025.

This was a cross-sectional, descriptive and retrospective study based on the medical records of patients seen in outpatient psychiatric consultation during the study period. Sampling was exhaustive. Records of patients seen during the study period were included; damaged or incomplete records were excluded.

Data were collected using a survey form designed with Google Forms, covering sociodemographic characteristics (age, sex, marital status, occupation, region of origin), clinical data (reasons for consultation, personal history, time to consultation, duration of illness, ICD-11 diagnosis) and therapeutic modalities. Data entry was performed with Microsoft Excel 2013 and analysis with Epi Info software, version 7.2.6.0. The reasons for consultation, medical history, psychiatric diagnosis, and treatments were extracted chronologically from the medical records using a digital survey form, in the order they appeared on the files. Only one or two diagnoses were selected based on the indication listed in the medical file, including the patients’ personal medical or surgical history. It was the investigator who took care of checking the coding according to ICSD-11.

The main limitations of the study were the poor archiving of some medical records and the absence of an inpatient ward in the department. Data collection was carried out with strict confidentiality and respect for patient anonymity. The study was approved by the Director of the Saint-Louis Regional Hospital.

Female patients predominated, accounting for 57.48% of participants versus 42.52% male, corresponding to a female sex ratio of 1.35. The 21 - 30-year age group was the most represented (28.29%), followed by the 31 - 40-year group (22.74%). Single patients accounted for 47.99% of the sample and married patients for 42.88%. Among women, married status (50.31%) exceeded single status, whereas among men, single status predominated (64.42%). More than half of the patients (53.18%) had no children, and 38.76% had between 1 and 5. Occupationally, housewives represented 39.30% of the sample, followed by informal-sector workers (22.74%); only 6.36% of patients held a formal-sector occupation. Almost all patients (86.57%) resided in the Saint-Louis region. Sociodemographic characteristics were presented in Table 1.

Table 1.Main sociodemographic characteristics of patients (n = 1117).

The most frequently reported reasons for consultation were insomnia (19.64%), seizures (15.07%), incoherent speech (10.21%), psychomotor agitation (8.08%) and various somatic complaints (5.67%), several reasons often coexisting in the same patient. Consultation was jointly requested by the patient and family in 38.32% of cases, by the family alone in 26.41% of cases, and by the patient alone in 35.00% of cases. The time elapsed between symptom onset and consultation was between 1 and 6 months for 59.09% of patients, less than one month for 9.40%, and more than 6 months for 31.51%. Women tended to consult slightly earlier than men, both within the first month (10.44% versus 8.00%) and between 1 and 6 months (59.19% versus 58.95%).

Among the patients, 71.89% were already followed in the department and 28.11% were consulting for the first time. A personal psychiatric history was found in 47.45% of patients. Regarding general medical history, 66.25% of patients had no notable antecedent; epilepsy (32.5%) and hypertension (5.3%) were the most frequent. The duration of illness at the time of diagnosis was 1 to 5 years in 29.10% of patients, 6 to 10 years in 18.98%, and less than 6 months in 12.26%. Substance use was reported by 5.64% of patients.

According to ICD-11, epilepsy was the most frequent diagnosis (32.50%), followed by schizophrenia (19.25%), acute and transient psychotic disorder (10.92%), bipolar disorder (5.73%), and mental or behavioral disorders associated with pregnancy, childbirth or the puerperium (5.10%), as mentioned in Table 2. Epilepsy and intellectual developmental disorder predominated among patients under 20 years, whereas schizophrenia, bipolar disorder and acute psychotic disorder were more frequent after age 20; neurocognitive disorders predominated after age 60 (25.68% in this age group).

Table 2. Distribution of the main psychiatric diagnoses according to ICD-11 (n = 1117).

Antipsychotics constituted the most frequently prescribed therapeutic class (48.8%), followed by antiepileptics (32.4%), synthetic antiparkinsonian agents (28.8%), anxiolytics (16.3%) and hypnotics (11.9%). The Table 3 summarized therapeutic modalities. Supportive psychotherapy was provided to 4.2% of patients. Outpatient care was delivered in the absence of a dedicated inpatient ward in the department. Under treatment, 60.79% of patients were in ongoing remission, 13.79% in complete remission, and 25.43% experienced relapse, most often following treatment discontinuation.

Table 3. Therapeutic management modalities (n = 1117, multiple responses possible).

The female predominance found in our study (57.48%) is comparable to that reported by Sall et al. at the Thiaroye National Psychiatric Hospital Center in 2025 [7], but differs from the results of Fall et al. in 2008 at the same institution [8], who found a male predominance. This difference could be explained by a tendency of women to seek medical help earlier, whereas the male predominance observed in other studies could reflect the demographic structure of the country, the Senegalese population comprising 50.6% men versus 49.4% women according to the 5th general population census [9], as well as a higher population density in Dakar.

The 21 - 30-year age group, which predominated in our sample, corresponds to the typical age of onset of many mental disorders [10]. This result is close to that of Sall et al. [7] and Gueye et al. in Saint-Louis [6], as well as that of Belghazi et al. in Morocco [11]. The mean age of the Senegalese population, estimated at 23.6 years in 2023 [9], partly explains the high proportion of young adults.

The high proportion of single patients, particularly among men (64.42%), and the absence of children in more than half of the patients (53.18%) may be explained by the presence of pupils and students in the sample, but also by the functional impact of chronic mental disorders, particularly psychotic disorders, which are recognized as disabling and may compromise access to marriage and family life [12].

Insomnia and incoherent speech were among the leading reasons for consultation, as in the study by Sall et al. [7]. The high frequency of seizures in our series reflects the organization of the department, which historically dedicates specific consultation days to epileptic patients, the head of department also being a neurophysiologist and epileptologist. This finding differs from that of Notue et al. in Mali, where aggressiveness and substance use dominated the reasons for consultation [13].

The time to consultation, between 1 and 6 months for the majority of patients, was longer than that reported in several Ivorian studies conducted between 2007 and 2013, where the delay was generally under 3 months [14][15]. Initial recourse to religious guides or traditional healers, lack of awareness of psychiatric care options, financial constraints and distance from care facilities are among the explanations put forward in the local literature for this delay [6].

Epilepsy was the most frequent diagnosis in our series (32.50%), followed by schizophrenia (19.25%) and acute and transient psychotic disorder (10.47%). This predominance of epilepsy is explained by the historical organization of the department, which, since its creation in 1987, has managed both psychiatric and neurological patients, a practice maintained even after the creation of a separate neurology department [16]. Schizophrenia is one of the recurring disorders in our study (19.25%). The illness generally begins in late adolescence or young adulthood between 15 and 25 years of age, with the first episodes occurring before age 18. The age of onset is generally later in women compared to men; the sex ratio is fairly balanced, although there is a slight predominance and more debilitating forms in men [10]. Neurocognitive disorders predominated after age 60, in line with the dementia literature [17].

The use of antipsychotics in neurological conditions is indicated for interictal epileptic psychoses. These encompass all psychotic disorders occurring in full consciousness in an individual previously diagnosed with epilepsy, and which do not immediately follow the onset of a seizure. Some antipsychotics (clozapine, olanzapine, quetiapine) can lower the seizure threshold, but prescribing antipsychotics to an epileptic patient already treated with antiepileptic drugs is, in practice, safe [18][19]. Psychotherapy, delivered by the department’s psychiatrists, remained marginal (4.2%), a finding similar to that reported by Loucar et al. in Dakar [20]. In the absence of an inpatient ward, ambulatory injectable treatment combined with oral medication allowed sustained management until the next scheduled visit.

Remission, complete or ongoing, was observed in more than 70% of patients under well-conducted treatment, a result higher than that of Fall et al., who reported a favorable outcome in 55% of patients [8]. Stopping antipsychotic treatment carries a high risk of psychotic relapse, often exceeding 75% in cases of abrupt discontinuation. This risk is slightly above 50% when the discontinuation extends between 1 and 10 weeks, and approaches 30% for discontinuation lasting more than 10 weeks [21]. This risk decreases if the reduction is very gradual and carefully managed, but a recurrence of symptoms remains common.

This study has the limitations inherent to its retrospective, single-center design, notably the loss of numerous medical records due to insufficient archiving, as well as the absence of an inpatient service, which may have influenced the profile of patients managed exclusively on an outpatient basis.